Association Between Respiratory Tract Methicillin-Resistant Staphylococcus aureus and Survival in Cystic Fibrosis
Association Between Respiratory Tract Methicillin-Resistant Staphylococcus aureus and Survival in Cystic Fibrosis
复制标题
DOI：
10.1001/jama.2010.791
复制
发表时间：
2010-06-16
影响因子：
120.7
通讯作者：
Boyle, Michael P.
中科院分区：
文献类型：
--
作者：
Dasenbrook, Elliott C.;Checkley, William;Boyle, Michael P.
背景耐甲氧西林金黄色葡萄球菌（MRSA）在囊性纤维化（CF）患者呼吸道中的患病率显著增加;然而，其对CF结局的影响尚不清楚。由于CF中细菌感染和死亡之间的时间可以是几十年，因此长期随访的观察性研究非常适合于解决当前的知识缺口。目的确定与从未有MRSA培养阳性的患者相比，从CF患者的呼吸道分离MRSA是否与更差的生存率相关。和参与者队列研究的19833名CF患者年龄在6至45岁之间，在美国囊性纤维化基金会认可的中心就诊。患者于1996年1月至2006年12月期间入组，随访至2008年12月。考克斯回归模型与时间变化的协变量被用来比较CF患者和没有呼吸道MRSA的生存。主要结果测量时间从年龄在进入到年龄在死亡的任何caus.Results在137 819患者年的观察（中位数，7.3年/患者），2537 CF患者死亡和5759例患者检测到MRSA。无MRSA患者的死亡率为18.3例死亡（95%置信区间[CI]，17.5-19.1）/1000患者年，MRSA患者的死亡率为27.7例死亡（95% CI，25.3-30.4）/1000患者年。在MRSA感染者中，与MRSA相关的死亡归因风险百分比为34.0%（95%CI，26.7%-40.4%）。与MRSA相关的未校正风险比为1.47（95%CI，1.32-1.62）。在调整了与病情严重程度相关的时变协变量后，MRSA仍与较高的死亡风险相关（1.27; 95%CI，1.11-1.45）。JAMA. 2010; 303（23）：2386-2392
Context The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in the respiratory tract of individuals with cystic fibrosis (CF) has increased dramatically; however, its impact on outcomes in CF is unclear. Because the time between infection with bacteria in CF and death can be decades, observational studies with long periods of follow-up are well suited to address the current gap in knowledge.Objective To determine whether isolation of MRSA from the respiratory tract of CF patients is associated with worse survival compared with patients who never have a culture positive for MRSA.Design, Setting, and Participants Cohort study of 19 833 CF patients aged 6 to 45 years seen at centers accredited by the Cystic Fibrosis Foundation in the United States. Patients entered between January 1996 and December 2006 and were followed up through December 2008. Cox regression models with time-varying covariates were used to compare survival between CF patients with and without respiratory tract MRSA.Main Outcome Measure Time from age at entry until age at death from any cause.Results In 137 819 patient-years of observation (median, 7.3 years/patient), 2537 CF patients died and 5759 patients had MRSA detected. The mortality rate was 18.3 deaths (95% confidence interval [CI], 17.5-19.1) per 1000 patient-years in patients without MRSA and 27.7 deaths (95% CI, 25.3-30.4) per 1000 patient-years in those with MRSA. Among those with MRSA, the attributable risk percentage of death associated with MRSA was 34.0% (95% CI, 26.7%-40.4%). The unadjusted hazard ratio associated with MRSA was 1.47 (95% CI, 1.32-1.62). After adjustment for time-varying covariates associated with severity of illness, MRSA remained associated with a higher risk of death (1.27; 95% CI, 1.11-1.45).Conclusion Detection of MRSA in the respiratory tract of CF patients was associated with worse survival. JAMA. 2010; 303(23): 2386-2392