Cytotoxic Virulence Predicts Mortality in Nosocomial Pneumonia Due to Methicillin-Resistant Staphylococcus aureus
Cytotoxic Virulence Predicts Mortality in Nosocomial Pneumonia Due to Methicillin-Resistant Staphylococcus aureus
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DOI：
10.1093/infdis/jiu554
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发表时间：
2015-06-15
影响因子：
6.4
通讯作者：
Shopsin, Bo
中科院分区：
文献类型：
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作者：
Rose, Hannah R.;Holzman, Robert S.;Shopsin, Bo
目前的研究确定了可能改善耐甲氧西林金黄色葡萄球菌(MRSA)医院内肺炎管理的细菌因素。从386名参加抗生素疗效随机对照研究的患者中获得了分离株。对分离株进行毒力因子的产生和万古霉素敏感性的筛选。在调整了疾病严重程度和治疗方式等宿主因素后，细胞毒活性与死亡率呈强烈的负相关，但对临床治愈没有影响。细胞毒性低的菌株主要来自医疗保健相关克隆，表现出更高的万古霉素异耐药发生率，而且它们更容易从年龄更大和更虚弱的患者那里恢复过来。此外，细胞毒活性低的克隆与死亡和临床改善差有关。克隆特异性和减弱的毒力似乎与结果有关。据我们所知，这些是医院内肺炎中MRSA毒力与死亡率之间的第一个相关性。
The current study identified bacterial factors that may improve management of methicillin-resistant Staphylococcus aureus (MRSA) nosocomial pneumonia. Isolates were obtained from 386 patients enrolled in a randomized, controlled study of antibiotic efficacy. Isolates were screened for production of virulence factors and for vancomycin susceptibility. After adjustment for host factors such as severity of illness and treatment modality, cytotoxic activity was strongly and inversely associated with mortality; however, it had no effect on clinical cure. Isolates having low cytotoxicity, which were derived largely from healthcare-associated clones, exhibited a greater prevalence of vancomycin heteroresistance, and they were recovered more often from patients who were older and frailer. Additionally, a clone with low cytotoxic activity was associated with death and poor clinical improvement. Clone specificity and attenuated virulence appear to be associated with outcome. To our knowledge, these are the first correlations between MRSA virulence and mortality in nosocomial pneumonia.