能够重复识别的白 Staphylococcus aureus bacteremia 的临床亚现象型
Maaike C Swets1,2, Zsuzsa Bakk3, Annette C Westgeest1
1Department of Infectious Diseases, Leiden University Medical Center, Leiden University, Leiden, The Netherlands.
概括
在不同患者群体中确定了五种不同的Staphylococcus aureus bacteremia (SAB) 亚表型. 这些可重复的发现有助于解释SAB.
科学领域:
- 临床微生物学和传染病.
- 细菌感染的流行病学.
- 患者分层和个性化医疗.
背景情况:
- 金色葡萄球菌 (SAB) 呈现出显著的临床异质性,使管理和研究复杂化.
- 之前的研究已经确定了五种SAB亚现象,与结果和利芬素反应有关.
- 这项研究旨在在各种国际队列中验证这些亚现象型,包括具有高甲林耐药性黄金色杆菌 (MRSA) 率的国际队列.
研究的目的:
- 在地理上多样化的观察队列中识别和验证五种不同临床亚现型的黄金葡萄球菌菌病 (SAB).
- 评估这些亚表型在不同患者群体中的可重复性,包括那些患有MRSA和USA300克隆的高流行率患者.
主要方法:
- 对三个成年SAB队列的分析:英国 (n=463),荷兰 (n=490) 和美国 (n=755).
- 隐性类别分析应用于常规收集的临床数据以识别子类型.
- 包括患者人口统计数据,获取来源,并发病症和细菌基因型的数据.
主要成果:
- 在所有队列中确定了五种可重现的临床亚型: (A) 老年,心脏代谢问题; (B) 医院,导管相关; (C) 社区获得,转移性感染; (D) 慢性病; (E) 年轻,注射药物使用,转移性感染.
- 美国队列显示了较高的多重发病率和MRSA (40.2%),包括USA300 (14.7%).
- 亚表型A的90天死亡率最高;亚表型C和E经历了持续的细菌血症.
结论:
- 五种SAB的临床亚现象在各种观察队列中具有强大的复制性,包括具有高MRSA和USA300流行率的队列.
- 这些已识别的亚现象为理解和管理SAB固有的临床异质性提供了一个框架.
- 这些发现支持在未来的临床试验和管理策略中使用这些亚表型来分层患者.
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