Emergence of multidrug-resistant, community-associated, methicillin-resistant Staphylococcus aureus clone USA300 in men who have sex with men
Emergence of multidrug-resistant, community-associated, methicillin-resistant Staphylococcus aureus clone USA300 in men who have sex with men
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DOI：
10.7326/0003-4819-148-4-200802190-00204
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发表时间：
2008-02-19
影响因子：
39.2
通讯作者：
Perdreau-Remington, Francoise
中科院分区：
文献类型：
--
作者：
Diep, Binh An;Chambers, Henry F.;Perdreau-Remington, Francoise
背景资料：多药耐药、社区相关、耐甲氧西林金黄色葡萄球菌（MRSA）感染已被报道，但似乎是孤立的。目的：确定多重耐药MRSA克隆（USA 300）在旧金山弗朗西斯科的发病率，并确定感染的危险因素。设计：基于人口的调查和横断面研究，使用图表审查。设置：研究对象为旧金山弗朗西斯科的9家医院（基于人群的调查）和旧金山弗朗西斯科和波士顿的2家门诊（横断面研究）。结果：在旧金山弗朗西斯科，多重耐药USA 300感染的总发病率为每10万人26例（95%CI，16至36例/100 000人）;在8个相邻的邮政编码中，男性同性伴侣比例较高，发病率较高。男性-男性性别是多重耐药USA 300感染的危险因素（相对危险度，13.2 [CI，1.7 - 101.6]; P < 0.001），独立于既往MRSA感染（相对危险度，2.1 [CI，1.2 - 3.7]; P=0.007）或克林霉素使用（相对危险度，2.1 [CI，1.2 - 3.61; P=0.007）。这种风险似乎与艾滋病毒感染无关。在旧金山弗朗西斯科，多重耐药USA 300最常表现为臀部、生殖器或会阴感染。在波士顿，感染是完全从男性与男性发生性关系的人身上恢复过来的。局限性：这项研究是回顾性的，性风险行为没有评估。结论：多重耐药的USA 300 MRSA感染在男性与男性发生性关系的人中很常见，多重耐药的MRSA感染可能在这一人群中通过性传播。需要进一步的研究来确定现有的控制其他性传播感染流行的努力是否可以控制社区相关的耐多药MRSA的传播。
Background: Infection with multidrug-resistant, community-associated, methicillin-resistant Staphylococcus aureus (MRSA) has been reported but seems to be isolated.Objective: To determine the incidence of a multidrug-resistant MRSA clone (USA300) in San Francisco, and to determine risk factors for the infection.Design: Population-based survey and cross-sectional study using chart review.Setting: 9 hospitals in San Francisco (population-based survey) and 2 outpatient clinics in San Francisco and Boston (cross-sectional study).Patients: Persons with culture-proven MRSA infections in 2004 to 2006.Measurements: Annual incidence, spatial clustering, and risk factors for multidrug-resistant USA300 infection. Pulsed-field gel electrophoresis, polymerase chain reaction assays, and DNA sequencing were used to characterize MRSA isolates.Results: The overall incidence of multidrug-resistant USA300 infection in San Francisco was 26 cases per 100 000 persons (95% CI, 16 to 36 cases per 100 000 persons); the incidence was higher in 8 contiguous ZIP codes with a higher proportion of male same-sex couples. Male-male sex was a risk factor for multidrug-resistant USA300 infection (relative risk, 13.2 [CI, 1.7 to 101.6]; P < 0.001) independent of past MRSA infection (relative risk, 2.1 [CI, 1.2 to 3.7]; P=0.007) or clinclamycin use (relative risk, 2.1 [1.2 to 3.61; P=0.007). The risk seemed to be independent of HIV infection. In San Francisco, multidrug-resistant USA300 manifested most often as infection of the buttocks, genitals, or perineum. In Boston, the infection was recovered exclusively from men who had sex with men.Limitations: The study was retrospective, and sexual risk behavior was not assessed.Conclusion: Infection with multidrug-resistant USA300 MRSA is common among men who have sex with men, and multidrug-resistant MRSA infection might be sexually transmitted in this population. Further research is needed to determine whether existing efforts to control epidemics of other sexually transmitted infections can control spread of community-associated, multidrug-resistant MRSA.