Changing epidemiology of methicillin-resistant Staphylococcus aureus in the Veterans Affairs Healthcare System, 2002-2009
Changing epidemiology of methicillin-resistant Staphylococcus aureus in the Veterans Affairs Healthcare System, 2002-2009
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DOI：
10.1007/s15010-011-0232-3
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发表时间：
2012-06-01
期刊：
影响因子：
7.5
通讯作者：
LaPlante, K. L.
中科院分区：
文献类型：
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作者：
Caffrey, A. R.;LaPlante, K. L.
耐甲氧西林金黄色葡萄球菌（MRSA）引起的感染的流行病学正在发生变化。必须描述医疗保健环境之间的时间趋势和差异，以便更好地预测与这种危险细菌感染相关的未来风险因素。2002年至2009年，美国退伍军人事务部医疗保健系统确定了全国MRSA感染队列：医院（HOS）、长期护理（LTC）和门诊（OPT）。我们使用广义线性混合模型分析了设定时间内的趋势，并使用卡方（2）和Wilcoxon秩和检验分析了设定间的差异。金黄色葡萄球菌、甲氧西林敏感的S.金黄色葡萄球菌（MSSA）和MRSA感染在所有三种情况下均随时间显著增加（P < 0.001）。MRSA发病率在HOS、LTC和OPT环境中分别每年上升14%、10%和37%。在56，345名MRSA感染患者中，LTC住院患者（n = 4，427）的合并症负担最高，门诊患者（n = 7，250）的合并症负担最低，与HOS住院患者（n = 44，668）相比，特定合并症的平均绝对差异分别为+2%和-7%。随着时间的推移，既往住院和手术（所有环境）、糖尿病并发症和手术部位感染（HOS，OPT）以及中位住院时间和住院死亡率（HOS，LTC）显著降低（P <0.02）。在过去的8年中，我们观察到MRSA感染的流行病学发生了显著变化，包括传统MRSA危险因素的减少，临床结果的改善，以及其他可能影响风险的患者特征的增加。
The epidemiology of infections caused by methicillin-resistant Staphylococcus aureus (MRSA) is changing. Temporal trends and differences between healthcare settings must be described in order to better predict future risk factors associated with this dangerous bacterial infection.A national MRSA-infected cohort was identified from 2002 to 2009 in the Veterans Affairs Healthcare System of the United States: hospital (HOS), long-term care (LTC), and outpatient (OPT). We analyzed within-setting time trends using generalized linear mixed models and between-setting differences with chi(2) and Wilcoxon rank-sum tests.The incidence of S. aureus, methicillin-susceptible S. aureus (MSSA), and MRSA infections increased significantly over time in all three settings based on modeled annual percentage changes (P < 0.001). MRSA incidence rates rose by 14, 10, and 37% per year in the HOS, LTC, and OPT settings, respectively. Among 56,345 MRSA-infected patients, the comorbidity burden was highest among LTC inpatients (n = 4,427) and lowest among outpatients (n = 7,250), with an average absolute difference in specific comorbidities of +2 and -7%, respectively, compared to HOS inpatients (n = 44,668). Over time, there was a significant (P a parts per thousand currency sign 0.02) decrease in previous inpatient admissions and surgeries (all settings); diabetes with complications and surgical site infections (HOS, OPT); and median length of stay and inpatient mortality (HOS, LTC). Alternatively, obesity, chronic renal disease, and depression were more common between 2002 and 2009 (P a parts per thousand currency sign 0.02).Over the past 8 years, we observed significant changes in the epidemiology of MRSA infections, including decreases in traditional MRSA risk factors, improvements in clinical outcomes, and increases in other patient characteristics that may affect risk.