Are Staphylococcus aureus Carrier Types Evidence of Population Heterogeneity?
Are Staphylococcus aureus Carrier Types Evidence of Population Heterogeneity?
复制标题
金黄色葡萄球菌携带者类型是群体异质性的证据吗？
DOI：
10.1093/aje/kwac201
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发表时间：
2023
影响因子：
5
通讯作者：
Toth,DamonJA
中科院分区：
文献类型：
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作者：
Beams,Alexander;Keegan,LindsayT;Adler,FrederickR;Samore,MatthewH;Khader,Karim;Toth,DamonJA
金黄色葡萄球菌无症状定植是感染的前兆，因此确定导致定植的传播模式和来源有助于有针对性的干预措施。纵向研究表明，有些人多年来一直被殖民，而另一些人似乎携带了y。金黄色持续数周或更短时间，传统观点将这种差异归因于持续被殖民的潜在风险因素。我们用获取和携带的数学模型来分析已发表的数据，以比较这一假设与其他假设。零模型假设一个均匀的群体，并且仍然产生高度可变的定殖持续时间（平均值= 101.7周；第5百分位，5.2周；第95百分位，304.7周）。模拟表明，这种固有的可变性，结合纵向队列研究中的审查，足以在数据中产生“持续携带者”、“间歇性携带者”和“非携带者”的外观。我们对定殖持续时间的估计对假阳性检测结果可能发生的假设很敏感，尽管这种情况很少见，但我们基于模型的方法同时估计了特异性和敏感性以及流行病学参数。我们的研究结果表明这是合理的。金黄色葡萄球菌不分青红皂白地在人体内定居，提高对导致定居的暴露类型的了解是至关重要的。
Asymptomatic colonization byStaphylococcus aureusis a precursor for infection, so identifying the mode and source of transmission which leads to colonization could help in targeting interventions. Longitudinal studies have shown that some people are persistently colonized for years, while others seem to carryS. aureusfor weeks or less, and conventional wisdom attributes this disparity to an underlying risk factor in the persistently colonized. We analyze published data with mathematical models of acquisition and carriage to compare this hypothesis with alternatives. The null model assumed a homogeneous population and still produced highly variable colonization durations (mean = 101.7 weeks; 5th percentile, 5.2 weeks; 95th percentile, 304.7 weeks). Simulations showed that this inherent variability, combined with censoring in longitudinal cohort studies, is sufficient to produce the appearance of “persistent carriers,” “intermittent carriers,” and “noncarriers” in data. Our estimates for colonization duration exhibited sensitivity to the assumption that false-positive test results can occur despite being rare, but our model-based approach simultaneously estimates specificity and sensitivity along with epidemiologic parameters. Our results show it is plausible thatS. aureuscolonizes people indiscriminately, and improved understanding of the types of exposures which result in colonization is essential.