Trends in prescribing β-lactam antibiotics for treatment of community-associated methicillin-resistant Staphylococcus aureus infections
Trends in prescribing β-lactam antibiotics for treatment of community-associated methicillin-resistant Staphylococcus aureus infections
复制标题
DOI：
10.1128/jcm.01510-07
复制
发表时间：
2007-12-01
影响因子：
9.4
通讯作者：
Dembry, Louise-Marie
中科院分区：
文献类型：
--
作者：
Gupta, Kalpana;MacIntyre, Ann;Dembry, Louise-Marie
对由分子和流行病学特征的社区相关耐甲氧西林金黄色葡萄球菌(CA-MRSA)分离株引起的皮肤和软组织感染(SSTI)患者在3年内作为初始经验治疗的β-内酰胺类抗生素的处方比率进行了评估。使用一个前瞻性开发的数据库来计算2004至2006年间CA-MRSA SSTI的流行率。对一组患者进行了MRSA分离株的分子表征和用于评估初始抗菌治疗的医疗记录回顾。在2,636名金黄色葡萄球菌感染患者中，CA-MRSA的患病率在2004年为9%，2005年为16%，2006年为21%(P<；0.0001，趋势卡方检验)。75%的CA-MRSA分离株是美国300或400克隆型的。92%的CA-MRSA分离株Panton-valine杀白素阳性，其中90%携带葡萄球菌染色体盒型。2004年、2005年和2006年，β-内酰胺类抗生素作为CA-MRSA SSTIs的初始经验性治疗的使用率分别为86%、77%和60%(趋势卡方检验，P=0.04)。30%的接受β-内酰胺治疗的患者有记录的CA-MRSA感染的危险因素。在过去的三年里，使用β-内酰胺类抗生素作为CA-MRSA SSTIs的初始经验疗法的情况显著减少。然而，即使CA-MRSA SSTIs的患病率接近25%，大多数患者仍在接受非活性抗菌治疗。需要进一步评估与CA-MRSA SSTIs的非协调性治疗相关的结果。
Rates of prescribing of beta-lactam antibiotics as initial empirical therapy for patients with skin and soft tissue infections (SSTIs) caused by molecularly and epidemiologically characterized community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) isolates were assessed over a 3-year period. A prospectively developed database was used to calculate the prevalence of CA-MRSA SSTIs from 2004 to 2006. Molecular characterization of the MRSA isolate and medical record review for assessment of initial antimicrobial therapy were performed on a subset of patients. Among 2,636 patients with S. aureus SSTIs, the prevalence of CA-MRSA was 9% in 2004, 16% in 2005, and 21% in 2006 (P < 0.0001, chi-square test for trend). Seventy-five percent of CA-MRSA isolates tested were of the USA 300 or 400 clone type. Ninety-two percent of CA-MRSA isolates tested were positive for Panton-Valentine leukocidin, of which 90% carried staphylococcal chromosomal cassette mec type IV. The rate of use of a beta-lactam antibiotic as initial empirical therapy for patients with CA-MRSA SSTIs was 86%, 77%, and 60% in 2004, 2005, and 2006, respectively (P = 0.04, chi-square test for trend). Thirty percent of beta-lactam-treated patients had a documented risk factor for CA-MRSA infection. The use of a beta-lactam antibiotic as initial empirical therapy for CA-MRSA SSTIs has decreased significantly over the past 3 years. However, even as the prevalence of CA-MRSA SSTIs approaches 25%, the majority of patients are still receiving inactive antimicrobial therapy. Further evaluation of the outcomes associated with discordant therapy for CA-MRSA SSTIs is needed.