Impact of USA300 Methicillin-Resistant Staphylococcus aureus on Clinical Outcomes of Patients With Pneumonia or Central Line-Associated Bloodstream Infections
Impact of USA300 Methicillin-Resistant Staphylococcus aureus on Clinical Outcomes of Patients With Pneumonia or Central Line-Associated Bloodstream Infections
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DOI：
10.1093/cid/cis408
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发表时间：
2012-07-15
影响因子：
11.8
通讯作者：
Fridkin, Scott K.
中科院分区：
文献类型：
--
作者：
Lessa, Fernanda C.;Mu, Yi;Fridkin, Scott K.
背景。USA300耐甲氧西林金黄色葡萄球菌（MRSA）菌株最初是作为社区相关感染的原因出现的，最近已成为医疗保健相关感染（HAIs）的重要病原体。然而，它对患者预后的影响尚未得到很好的研究。我们对侵袭性MRSA感染患者进行了评估，以评估USA100和usa300引起的感染结果的差异。基于人群的侵袭性MRSA感染数据用于确定2个队列：(1)2005-2007年期间来自美国6个大都市地区的非透析中心静脉相关血流感染（CLABSIs）患者和(2)社区发病肺炎（PNEUMO）患者。我们回顾了确诊的MRSA USA100或USA300感染患者的医疗记录。进行Logistic回归，并在适当时进行生存分析，以评估死亡率、早期和晚期并发症以及住院时间。CLABSI组和PNEUMO组分别纳入236例和100例患者。USA300是肺炎患者早期并发症的唯一独立预测因子（优势比[OR]， 2.6; P = .02）。CLABSI晚期并发症的独立预测因子包括MRSA培养前重症监护病房（ICU）入住情况（调整后的OR [AOR]， 2.1; P = 0.01）和Charlson合并症指数（AOR, 2.6; P = 0.003），但不包括菌株类型。肺炎患者年龄较大（P = 0.02）、黑色皮肤（P < 0.001）或感染USA100菌株（P = 0.02）更容易死亡，而CLABSI患者年龄较大（P < 0.001）、有合并症（P < 0.001）或在MRSA培养前曾住过ICU （P = 0.001）更容易死亡。USA300与PNEUMO患者的早期并发症相关。然而，它与PNEUMO或CLABSI患者的死亡率无关。对USA300引起的HAIs死亡率较高的担忧可能没有根据。
Background. The USA300 methicillin-resistant Staphylococcus aureus (MRSA) strain, which initially emerged as a cause of community-associated infections, has recently become an important pathogen in healthcare-associated infections (HAIs). However, its impact on patient outcomes has not been well studied. We evaluated patients with invasive MRSA infections to assess differences in outcomes between infections caused by USA100 and those caused by USA300.Methods. Population-based data for invasive MRSA infections were used to identify 2 cohorts: (1) nondialysis patients with central line-associated bloodstream infections (CLABSIs) and (2) patients with community-onset pneumonia (PNEUMO) during 2005-2007 from 6 US metropolitan areas. Medical records of patients with confirmed MRSA USA100 or USA300 infection were reviewed. Logistic regression and, when appropriate, survival analysis was performed to evaluate mortality, early and late complications, and length of stay.Results. A total of 236 and 100 patients were included in the CLABSI and PNEUMO cohorts, respectively. USA300 was the only independent predictor of early complications for PNEUMO patients (odds ratio [OR], 2.6; P = .02). Independent predictors of CLABSI late complications included intensive care unit (ICU) admission before MRSA culture (adjusted OR [AOR], 2.1; P = .01) and Charlson comorbidity index (AOR, 2.6; P = .003), but not strain type. PNEUMO patients were significantly more likely to die if they were older (P = .02), black (P < .001), or infected with USA100 strain (P = .02), whereas those with CLABSI were more likely to die if they were older (P < .001), had comorbidities (P < .001), or had an ICU admission before MRSA culture (P = .001).Conclusions. USA300 was associated with early complications in PNEUMO patients. However, it was not associated with mortality for either PNEUMO or CLABSI patients. Concerns regarding higher mortality from HAIs caused by USA300 may not be warranted.