Duration of Colonization and Determinants of Earlier Clearance of Colonization With Methicillin-Resistant Staphylococcus aureus
Duration of Colonization and Determinants of Earlier Clearance of Colonization With Methicillin-Resistant Staphylococcus aureus
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DOI：
10.1093/cid/civ075
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发表时间：
2015-05-15
影响因子：
11.8
通讯作者：
Lautenbach, Ebbing
中科院分区：
文献类型：
--
作者：
Cluzet, Valerie C.;Gerber, Jeffrey S.;Lautenbach, Ebbing
背景社区发生耐甲氧西林金黄色葡萄球菌皮肤和软组织感染（SSTI）后耐甲氧西林金黄色葡萄球菌（MRSA）的定植时间和清除相关因素尚不清楚。我们对2010年1月1日至2012年12月31日在5家成人和儿科学术医院就诊的急性MRSA SSTI患者进行了一项前瞻性队列研究。索引患者和家庭成员每2周进行一次MRSA定植自我采样，持续6个月。定植清除定义为连续2个采样期内MRSA监测培养阴性。建立了考克斯比例风险回归模型以确定定植清除的决定因素。纳入243例索引患者。SSTI诊断后MRSA定植的中位持续时间为21天（95%置信区间[CI]，19 - 24），19.8%从未清除定植。用克林霉素治疗SSTI与早期清除相关（风险比[HR]，1.72; 95%CI，1.28 - 2.30; P <0.001）。年龄较大（HR，0.99; 95% CI，0.98 - 1.00; P = 0.01）与定植持续时间较长相关。在索引患者中，MRSA定植的家庭成员数量增加与定植清除延迟之间存在边界显著相关性（HR，0.85; 95% CI，0.71 - 1.01; P = 0.06）。通过系统的定期采样方案，MRSA定植的持续时间比以前报告的要短，尽管19.8%的患者在6个月时仍定植。克林霉素与MRSA SSTI后定植持续时间较短之间的相关性表明，选择用于治疗MRSA感染的抗生素可能发挥作用。
Background. The duration of colonization and factors associated with clearance of methicillin-resistant Staphylococcus aureus (MRSA) after community-onset MRSA skin and soft-tissue infection (SSTI) remain unclear.Methods. We conducted a prospective cohort study of patients with acute MRSA SSTI presenting to 5 adult and pediatric academic hospitals from 1 January 2010 through 31 December 2012. Index patients and household members performed self-sampling for MRSA colonization every 2 weeks for 6 months. Clearance of colonization was defined as negative MRSA surveillance cultures during 2 consecutive sampling periods. A Cox proportional hazards regression model was developed to identify determinants of clearance of colonization.Results. Two hundred forty-three index patients were included. The median duration of MRSA colonization after SSTI diagnosis was 21 days (95% confidence interval [CI], 19-24), and 19.8% never cleared colonization. Treatment of the SSTI with clindamycin was associated with earlier clearance (hazard ratio [HR], 1.72; 95% CI, 1.28-2.30; P < .001). Older age (HR, 0.99; 95% CI, .98-1.00; P = .01) was associated with longer duration of colonization. There was a borderline significant association between increased number of household members colonized with MRSA and later clearance of colonization in the index patient (HR, 0.85; 95% CI, .71-1.01; P = .06).Conclusions. With a systematic, regular sampling protocol, duration of MRSA colonization was noted to be shorter than previously reported, although 19.8% of patients remained colonized at 6 months. The association between clindamycin and shorter duration of colonization after MRSA SSTI suggests a possible role for the antibiotic selected for treatment of MRSA infection.