Community-onset methicillin-resistant Staphylococcus aureus associated with antibiotic use and the cytotoxin Panton-Valentine leukocidin during a furunculosis outbreak in rural Alaska
Community-onset methicillin-resistant Staphylococcus aureus associated with antibiotic use and the cytotoxin Panton-Valentine leukocidin during a furunculosis outbreak in rural Alaska
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DOI：
10.1086/383247
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发表时间：
2004-05-01
影响因子：
6.4
通讯作者：
Butler, JC
中科院分区：
文献类型：
--
作者：
Baggett, HC;Hennessy, TW;Butler, JC
背景社区发病耐甲氧西林金黄色葡萄球菌（CO-MRSA）的报告越来越多，感染往往涉及软组织。在阿拉斯加州的CO-MRSA皮肤感染爆发期间，我们评估了疾病的危险因素以及毒力因子Panton-Valentine杀白细胞素（PVL）是否可以解释该地区MRSA皮肤感染的高发病率。我们进行了S。在暴发地区的金黄色葡萄球菌监测和一个社区的病例对照研究，比较34例MRSA皮肤感染患者和94名对照受试者。对传统桑拿进行了全面评价。S.应用聚合酶链反应（PCR）技术检测金黄色葡萄球菌PVL基因，应用脉冲场凝胶电泳（PFGE）技术分析菌株间的亲缘关系。在爆发前12个月内，病例患者比对照组接受了更多的抗生素疗程（中间人，4对2个疗程; P = 0.01），并且比对照组更有可能使用MRSA定植的桑拿浴（44%对13%;年龄调整的比值比，4.6; 95%置信区间，1.7-12）。113株MRSA中110株（97%）存在PVL基因，而81株甲氧西林敏感的S.金黄色葡萄球菌（P <0.001）。PFGE结果显示，大多数MRSA分离株的亲缘关系较近。携带PVL的耐药菌株的选择性抗生素压力可能导致CO-MRSA在阿拉斯加农村的出现和传播。
Background. Community-onset methicillin-resistant Staphylococcus aureus (CO-MRSA) reports are increasing and infections often involve soft tissue. During a CO-MRSA skin infection outbreak in Alaska, we assessed risk factors for disease and whether a virulence factor, Panton-Valentine leukocidin (PVL), could account for the high rates of MRSA skin infection in this region.Methods. We conducted S. aureus surveillance in the Outbreak region and a case-control study in I community, comparing 34 case patients with MRSA skin infection with 94 control subjects. Ail assessment of traditional saunas was performed. S. aureus isolates from regional surveillance were screened for PVL genes by Use Of polymerase chain reaction, and isolate relatedness was determined by Use Of pulsed-field gel electrophoresis (PFGE).Results. Case patients received more antibiotic courses during the 12 months before the Outbreak than did control SLibjccts (inedian, 4 vs. 2 courses; P =.01) and were more likely to Use MRSA-colonized saunas than were control subjects (44% vs. 13%; age-adjusted odds ratio, 4.6; 95% confidence interval, 1.7-12). The PVL genes were present in 110 (97%) of 113 MRSA isolates, compared with 0 of 81 methicillin-susceptible S. aureus isolates (P < .001). The majority of MRSA isolates were closely related by PFGE.Conclusion. Selective antibiotic pressure for drug-resistant strains carrying PVL may have led to the emergence and spread of CO-MRSA in rural Alaska.