Risk factors for persistent methicillin-resistant Staphylococcus aureus infection in cystic fibrosis
Risk factors for persistent methicillin-resistant Staphylococcus aureus infection in cystic fibrosis
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DOI：
10.1016/j.jcf.2017.04.010
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发表时间：
2017-11-01
影响因子：
5.2
通讯作者：
Merlo, Christian A.
中科院分区：
文献类型：
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作者：
Jennings, Mark T.;Dasenbrook, Elliot C.;Merlo, Christian A.
背景：耐甲氧西林金黄色葡萄球菌（MRSA）已成为囊性纤维化（CF）的重要病原体。在美国，超过25%的CF患者在呼吸道培养标本中发现MRSA，持续的MRSA感染与肺功能更快下降和死亡率增加有关。本研究的目的是调查与CF人群中持续性MRSA感染相关的临床和人口统计学特征。方法：这是一项回顾性队列研究，对象是囊性纤维化基金会患者登记处2002年至2012年随访的个人。持续性MRSA感染的发展进行了时间到事件的分析，多变量考克斯比例风险模型构建，以确定感染的危险因素。结果：研究队列包括19,434人，其中5844将开发持续性MRSA感染。在调整模型中，胰腺功能不全（HR：1.49; 95% CI：1.29-1.72），CF相关糖尿病（BR：1.13; 95% CI：1.05-1.20），合并感染铜绿假单胞菌（HR：1.21; 95% CI：1.13-1.28）和住院次数/年（HR：1.09; 95%CI：1.06-1.12）均与风险增加相关，而较高的社会经济地位（HR：0.87; 95% CI：0.82-0.93）与较低的风险相关。在CF中心接受治疗的MRSA患病率增加与MRSA感染风险增加相关：最高四分位数（HR：2.33; 95%CI：2.13-2.56）。结论：本研究中未发现易改变的持续性MRSA风险因素。然而，确定了持续性MRSA感染风险较高的患者的几个风险因素，例如基线MRSA患病率较高的中心，并且可能有助于设计中心特异性MRSA感染预防和控制策略和/或根除方案。需要进一步的研究来评估关注这些风险因素是否可以改善临床结局。(c)2017年欧洲囊性纤维化协会。Elsevier B. V.出版，保留所有权利。
Background: Methicillin-resistant Staphylococcus aureus (MRSA) has emerged as an important pathogen in cystic fibrosis (CF). Over 25% of individuals in the United States with CF are found to have MRSA in respiratory culture specimens, and persistent MRSA infection has been associated with more rapid decline in lung function and increased mortality. The objective of this study was to investigate clinical and demographic characteristics that are associated with the development of persistent MRSA infection in a CF population.Methods: This was a retrospective cohort study of individuals followed from 2002 to 2012 in the Cystic Fibrosis Foundation Patient Registry. A time-to-event analysis for the development of persistent MRSA infection was performed, and multivariable Cox proportional hazards models were constructed to identify risk factors for infection.Results: The study cohort included 19,434 individuals, of which 5844 would develop persistent MRSA infection. In the adjusted model, pancreatic insufficiency (HR: 1.49; 95% CI: 1.29-1.72), CF related diabetes (BR: 1.13; 95% CI: 1.05-1.20), co-infection with P. aeruginosa (HR: 1.21; 95% CI: 1.13-1.28), and number of hospitalizations/year (HR: 1.09; 95% CI: 1.06-1.12) were all associated with increased risk, whereas higher socioeconomic status (HR: 0.87; 95% CI: 0.82-0.93) was associated with a lower risk. Receiving care at a CF center with increased MRSA prevalence was associated with increased risk of MRSA infection: highest quartile (HR: 2.33; 95% CI: 2.13-2.56).Conclusions: No easily modifiable risk factors for persistent MRSA were identified in this study. However, several risk factors for patients at higher risk for persistent MRSA infection were identified, for example centers with a high baseline MRSA prevalence, and may be useful in designing center-specific MRSA infection prevention and control strategies and/or eradication protocols. Additional studies are needed in order to evaluate if attention to these risk factors can improve clinical outcomes. (c) 2017 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.