Emergence of community-associated methicillin-resistant Staphylococcus aureus USA300 genotype as a major cause of health care-associated blood stream infections
Emergence of community-associated methicillin-resistant Staphylococcus aureus USA300 genotype as a major cause of health care-associated blood stream infections
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DOI：
10.1086/499815
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发表时间：
2006-03-01
影响因子：
11.8
通讯作者：
Blumberg, HM
中科院分区：
文献类型：
--
作者：
Seybold, U;Kourbatova, EV;Blumberg, HM
背景资料。社区相关的耐甲氧西林金黄色葡萄球菌(MRSA)基因型别(如USA300)是否是血液感染(BSI)和卫生保健相关感染的主要原因尚未明确。在一家城市公立医院前瞻性地收集了从BSI患者身上恢复的连续MRSA分离株。进行了分子分型研究。对MRSA USA300基因型的患病率和危险因素进行分析。2004年有132例MRSA BSI病例记录在案(发病率为6.79/1000)；有116个分离株可用于基因分型。116个可评估病例的特征包括：平均年龄47岁；62%是男性，82%是非裔美国人，22%是艾滋病毒血清阳性。粗住院死亡率为22%。107例(92%)在感染前一年内与医疗机构有过接触，49例(42%)发生医院感染(定义为入院后148h血培养阳性)。聚合酶链式反应检测显示，116株分离株中39株(34%)为MRSA USA300，34株(29%)为USA100，42株(36%)为USA500，1株(1%)为USA800。MRSA USA300占卫生保健相关BSI的28%，占医院MRSA BSI的20%。在多因素分析中，USA300基因的分离与注射吸毒(OR，3.67；95%CI，1.10~12.28)和皮肤软组织感染(OR，4.26；95%CI，1.08~16.84)相关。居住在长期护理机构的患者(OR，0.09；95%CI，0.01-0.82)和前一年接受抗菌药治疗的患者恢复MRSA USA300基因的可能性较小(OR，0.10；95%CI，0.02-0.49)。MRSA USA300基因型是我们地区(佐治亚州亚特兰大)社区相关MRSA感染的主要原因，现在已成为卫生保健相关和医院内BSI的重要原因。耐甲氧西林金黄色葡萄球菌USA300作为一种医院内致病菌，对感染控制程序提出了新的挑战。
Background. Whether community-associated methicillin-resistant Staphylococcus aureus (MRSA) genotypes ( e. g., USA300) are a major cause of bloodstream infections (BSIs) and health care-associated infections has been poorly defined.Methods. Consecutive MRSA isolates recovered from patients with BSIs were prospectively collected at an urban public hospital. Molecular typing studies were performed. Prevalence and risk factors for the MRSA USA300 genotype were assessed.Results. One hundred thirty-two cases of MRSA BSI were documented over 7.5 months in 2004 ( incidence, 6.79 per 1000 admissions); 116 isolates were available for genotyping. Characteristics of the 116 evaluable cases included: a mean age 47 years; 62% were male, 82% were African American, and 22% were HIV seropositive. The crude in-hospital mortality rate was 22%. In 107 cases (92%), there was contact with a health care facility within the year prior to infection, and a nosocomial infection ( defined as positive blood culture results obtained 148 h after admission) occurred in 49 cases (42%). PFGE demonstrated that 39 (34%) of the 116 isolates were the MRSA USA300 genotype; 34 (29%) were USA100; 42 (36%) were USA500; and 1 (1%) was USA800. MRSA USA300 accounted for 28% of health care-associated BSIs and 20% of nosocomial MRSA BSIs. In multivariate analysis, isolation of the USA300 genotype was associated with injectiondrug use ( OR, 3.67; 95% CI, 1.10 - 12.28) and skin and soft tissue infection ( OR, 4.26; 95% CI, 1.08-16.84). Patients who resided in long-term care facilities ( OR, 0.09; 95% CI, 0.01-0.82) and those who were treated with antimicrobials in the prior year were less likely to have MRSA USA300 genotype recovered ( OR, 0.10; 95% CI, 0.02-0.49).Conclusions. MRSA USA300 genotype, the predominant cause of community-associated MRSA infections in our area ( Atlanta, GA), has now emerged as a significant cause of health care - associated and nosocomial BSI. MRSA USA300 as a nosocomial pathogen presents new challenges to infection control programs.