Association of methicillin-resistant Staphylococcus aureus (MRSA) USA300 genotype with mortality in MRSA Bacteremia
Association of methicillin-resistant Staphylococcus aureus (MRSA) USA300 genotype with mortality in MRSA Bacteremia
复制标题
DOI：
10.1016/j.jinf.2010.09.021
复制
发表时间：
2010-11-01
影响因子：
28.2
通讯作者：
Ray, Susan M.
中科院分区：
文献类型：
--
作者：
Kempker, Russell R.;Farley, Monica M.;Ray, Susan M.
目的：为了评估USA 300基因型与MRSA菌血症患者结局的相关性，并研究MRSA菌血症随时间推移的流行病学。方法：2005年至2008年，在亚特兰大8个县进行了以人群为基础的MRSA菌血症监测。MRSA菌血症病例被分类为医疗保健相关医院发病（HAHO）、医疗保健相关社区发病（HACO）或社区相关（CA）疾病。结果：共检出MRSA菌血症4344例，其中HACO 2579例（59.4%），HAHO 1144例（26.3%），CA 601例（13.8%）。MRSA菌血症的总体发病率从2005年的33.9/100，000下降到2008年的24.8/100，000。年龄≥ 65岁的人、黑人、男性和艾滋病患者的发病率最高。在1104例病例的多因素分析中，USA 300基因型与住院死亡率增加相关（HR 1.63，95%CI 1.19-2.23）。与USA 100株相比，USA 300株也与死亡率增加相关（HR 1.79，95%CI 1.24-2.58）。结论：MRSA菌血症发病率在4年内下降，但CA发病率保持稳定。艾滋病毒感染者、老年人和黑人受到的影响尤为严重。USA 300 MRSA菌株引起的菌血症与死亡率增加相关，表明USA 300菌株可能更具毒性。(C)2010年，英国传染病协会。由爱思唯尔有限公司出版。保留所有权利。
Objectives: To evaluate the association of USA300 genotype with outcomes in persons with MRSA bacteremia and examine the epidemiology of MRSA bacteremia over time.Methods: Population-based surveillance for MRSA bacteremia was performed in 8-county Atlanta from 2005 to 2008. Cases of MRSA bacteremia were classified as healthcare-associated hospital-onset (HAHO), healthcare-associated community-onset (HACO), or community-associated (CA) disease. A survival analysis was performed on a nested cohort of cases with isolates characterized by pulse field gel electrophoresis (PFGE).Results: 4344 MRSA bacteremia cases were identified; 2579 (59.4%) HACO, 1144 (26.3%) HAHO; and 601 (13.8%) CA. Overall incidence rates of MRSA bacteremia declined from 33.9/100,000 in 2005-24.8/100,000 in 2008. Rates were highest in persons >= 65 years, blacks, males, and persons with AIDS. In multivariate analysis of 1104 cases, USA300 genotype was associated with increased in-hospital mortality (HR 1.63, 95% CI 1.19-2.23). USA300 strains were also associated with increased mortality when compared to USA100 strains (HR 1.79, 95% CI 1.24-2.58).Conclusions: MRSA bacteremia incidence declined over 4 years but CA disease rates remained stable. Persons with HIV, the elderly, and blacks were disproportionately affected. Bacteremia due to USA300 MRSA strains was associated with increased mortality, suggesting that USA300 strains may be more virulent. (C) 2010 The British Infection Society. Published by Elsevier Ltd. All rights reserved.