与社区和医疗保健相关的甲素耐药黄金葡萄球菌感染的比较
Timothy S Naimi1, Kathleen H LeDell, Kathryn Como-Sabetti
1Acute Disease Investigation and Control Section, Minnesota Department of Health, Minneapolis, USA. tbn7@cdc.gov
JAMA
|December 11, 2003
概括
与社区相关的甲素耐药黄金葡萄球菌 (MRSA) 在患者人口统计学,临床表现和微生物特征方面不同于与医疗保健相关的MRSA. 这突显了不同的起源,并需要更新MRSA感染的治疗指南.
科学领域:
- 传染性疾病 传染性疾病
- 微生物学 微生物学
- 流行病学 流行病学
背景情况:
- 传统上与医疗保健环境相关的甲素耐药黄金葡萄球菌 (MRSA).
- 在没有传统风险因素的人群中出现社区相关的MRSA (CA-MRSA).
研究的目的:
- 为了比较CA-MRSA和医疗保健相关的MRSA (HA-MRSA) 的流行病学和微生物学特征.
主要方法:
- 2000年,在明尼苏达州的12个实验室进行了1100例MRSA感染的前性队列研究.
- 分析临床数据,隔离体敏感性,脉冲场凝电泳 (PFGE) 和外毒素基因配置文件.
主要成果:
- CA-MRSA病例较年轻 (中位数为23岁与68岁),更有可能患有皮肤/软组织感染 (75%与37%相比).
- CA-MRSA分离体对某些抗微生物药物的敏感性较高,但通常使用无效药物治疗.
- CA-MRSA菌株属于不同的PFGE群体,并拥有不同的外毒素基因,包括Panton Valentine leucocidin.
结论:
- CA-MRSA和HA-MRSA表现出显著的人口,临床和微生物学的差异.
- CA-MRSA很可能起源于医疗机构之外,独特的微生物特征推动了社区传播.
- 单独使用β-乳治疗不足以实证治疗严重的门诊性葡萄球菌感染.
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