Hospital-community interactions foster coexistence between methicillin-resistant strains of Staphylococcus aureus.
Hospital-community interactions foster coexistence between methicillin-resistant strains of Staphylococcus aureus.
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DOI：
10.1371/journal.ppat.1003134
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发表时间：
2013-02
期刊：
影响因子：
6.7
通讯作者：
Grenfell B
中科院分区：
文献类型：
--
作者：
Kouyos R;Klein E;Grenfell B
耐甲氧西林金黄色葡萄球菌（MRSA）是医院和社区发病和死亡的重要原因。传统上，MRSA主要是医院相关的（HA-MRSA），但在过去十年中，社区相关菌株（CA-MRSA）已广泛传播。CA-MRSA菌株似乎具有显著更低的耐药性生物学成本，因此推测它们可以在医院中取代HA-MRSA菌株。这种替代可能对公共卫生产生重大影响，因为两种菌株的耐药性谱存在差异，临床效果也可能存在差异。在这里，我们评估HA和CA-MRSA之间的竞争的影响，使用流行病学模型，整合药物使用频率，耐药谱，接触和年龄结构的现实数据。通过明确说明医院和社区中不同的抗生素使用频率，我们发现菌株之间的共存是一种可能的结果，因为选择有利于社区中的CA-MRSA，因为它的耐药成本较低，而它有利于医院中的HA-MRSA，因为它的耐药谱更广。将年龄和治疗结构的现实程度纳入模型中显著增加了可能共存的参数范围。因此，我们的研究结果表明，人群中存在的巨大异质性使得医院和社区相关MRSA菌株之间的共存成为可能的结果。耐甲氧西林金黄色葡萄球菌（MRSA）是最臭名昭著的耐药性细菌之一，它会导致从皮肤和软组织感染到肺炎和败血症的疾病。传统上，MRSA主要与医院相关，但在过去十年中，社区相关菌株已广泛传播。通常，耐药细菌的繁殖或传播率较低，称为适应性成本。由于估计社区相关菌株的成本显著较低，因此预测这些菌株最终将取代医院相关菌株。然而，医院相关菌株对更多种类的抗生素具有耐药性，这可能会补偿更高的健身成本。在这里，我们将药物使用，耐药性，接触和年龄结构的现实数据整合到MRSA传播的数学模型中，以预测医院和社区相关菌株之间的竞争。我们发现，对于一个现实程度的人口结构，很可能这两种菌株的MRSA将长期共存。这是由于不同年龄组之间的住院率和抗生素消耗率存在显著差异。特别是，老年人的抗生素使用率和住院率远远高于其他年龄组。这就产生了这样一种情况：社区相关菌株可以在社区中占主导地位，但在医院中却被击败，导致人群中共存。
Methicillin-resistant Staphylococcus aureus (MRSA) is an important cause of morbidity and mortality in both hospitals and the community. Traditionally, MRSA was mainly hospital-associated (HA-MRSA), but in the past decade community-associated strains (CA-MRSA) have spread widely. CA-MRSA strains seem to have significantly lower biological costs of resistance, and hence it has been speculated that they may replace HA-MRSA strains in the hospital. Such a replacement could potentially have major consequences for public health, as there are differences in the resistance spectra of the two strains as well as possible differences in their clinical effects. Here we assess the impact of competition between HA- and CA-MRSA using epidemiological models which integrate realistic data on drug-usage frequencies, resistance profiles, contact, and age structures. By explicitly accounting for the differing antibiotic usage frequencies in the hospital and the community, we find that coexistence between the strains is a possible outcome, as selection favors CA-MRSA in the community, because of its lower cost of resistance, while it favors HA-MRSA in the hospital, because of its broader resistance spectrum. Incorporating realistic degrees of age- and treatment-structure into the model significantly increases the parameter ranges over which coexistence is possible. Thus, our results indicate that the large heterogeneities existing in human populations make coexistence between hospital- and community-associated strains of MRSA a likely outcome. One of the most notorious cases of antibiotic-resistant bacteria is methicillin-resistant Staphylococcus aureus (MRSA), which causes diseases ranging from skin and soft-tissue infections to pneumonia and septicemia. Traditionally, MRSA was mainly hospital-associated, but in the past decade community-associated strains have spread widely. Typically drug-resistant bacteria have lower reproduction or transmission rates, called a fitness cost. Because this cost is estimated to be significantly lower for community-associated strains, it has been predicted that these will eventually replace the hospital-associated strains. However, hospital-associated strains are resistant against a greater variety of antibiotics, which may compensate for the higher fitness cost. Here, we integrate realistic data on drug-usage, resistance profiles, contact, and age structures into a mathematical model of MRSA transmission to predict the competition between hospital- and community-associated strains. We find that for a realistic degree of population structure it is likely that both strains of MRSA will coexist in the long term. This results from significantly different hospitalization and antibiotic consumption rates between age groups. In particular, elderly individuals have much higher rates of antibiotic usage and hospitalizations than other age groups. This generates a situation where community-associated strains can predominate in the community but are outcompeted in the hospital, resulting in coexistence in the population.
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