The environment as an unrecognized reservoir for community-associated methicillin resistant Staphylococcus aureus USA300: a case-control study.
The environment as an unrecognized reservoir for community-associated methicillin resistant Staphylococcus aureus USA300: a case-control study.
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DOI：
10.1371/journal.pone.0022407
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发表时间：
2011
期刊：
影响因子：
3.7
通讯作者：
Lowy FD
中科院分区：
文献类型：
--
作者：
Uhlemann AC;Knox J;Miller M;Hafer C;Vasquez G;Ryan M;Vavagiakis P;Shi Q;Lowy FD
社区相关的耐甲氧西林金黄色葡萄球菌（CA-MRSA）感染正在蔓延，但在非流行性环境中的感染源仍然不明确。我们进行了一项以社区为基础的病例对照研究，调查与MRSA感染相关的社会人口学危险因素和传染性储库。病例患者因CA-MRSA感染到纽约医院就诊。从医院的牙科诊所患者人群中随机选择无感染的对照组。在家访期间，病例组和对照组受试者完成了一份调查问卷，从指数应答者和家庭成员中收集鼻拭子，并对标准化的环境表面进行拭子。对S.金黄色葡萄球菌分离株我们招募了95例病例和95例对照受试者。家庭成员中报告糖尿病和皮肤感染的病例更多。病例家庭中有53户（56%）环境中存在沙门氏菌污染。金黄色葡萄球菌，相比之下，36（38%）对照家庭（p =.02）。 在30个（32%）病例家庭和5个（5%; p<0.001）对照家庭的污染物上检测到MRSA。20例患者（21%）鼻内定植MRSA，多于对照指数2例（2%; p<0.001）。在亚组分析中，临床分离株（主要是USA 300）在复发性MRSA感染的病例家庭（16/36，44%）的环境表面上比没有复发性MRSA感染的病例家庭（14/58，24%，p = 0.04）更常见。 感染沙门氏菌的家庭环境污染频率较高。金黄色葡萄球菌，特别是MRSA，暗示这是潜在的细菌储存库，增加了感染的风险。环境定殖可能有助于流行菌株（如USA 300）的社区传播。
Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections are spreading, but the source of infections in non-epidemic settings remains poorly defined. We carried out a community-based, case-control study investigating socio-demographic risk factors and infectious reservoirs associated with MRSA infections. Case patients presented with CA-MRSA infections to a New York hospital. Age-matched controls without infections were randomly selected from the hospital's Dental Clinic patient population. During a home visit, case and control subjects completed a questionnaire, nasal swabs were collected from index respondents and household members and standardized environmental surfaces were swabbed. Genotyping was performed on S. aureus isolates. We enrolled 95 case and 95 control subjects. Cases more frequently reported diabetes mellitus and a higher number of skin infections among household members. Among case households, 53 (56%) were environmentally contaminated with S. aureus, compared to 36 (38%) control households (p = .02). MRSA was detected on fomites in 30 (32%) case households and 5 (5%; p<.001) control households. More case patients, 20 (21%) were nasally colonized with MRSA than were control indexes, 2 (2%; p<.001). In a subgroup analysis, the clinical isolate (predominantly USA300), was more commonly detected on environmental surfaces in case households with recurrent MRSA infections (16/36, 44%) than those without (14/58, 24%, p = .04). The higher frequency of environmental contamination of case households with S. aureus in general and MRSA in particular implicates this as a potential reservoir for recolonization and increased risk of infection. Environmental colonization may contribute to the community spread of epidemic strains such as USA300.
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