Skull S A, Krause V, Coombs G, Pearman J W, Roberts L A
Aust N Z J Med. 1999 Feb;29(1):66-72. doi: 10.1111/j.1445-5994.1999.tb01590.x.
Staphylococcus aureus invasive infection remains a serious condition associated with considerable morbidity and mortality. Following notification of five cases at Royal Darwin Hospital (RDH), we searched for related cases, determined their epidemiological characteristics and attempted to identify the source of this apparent cluster.
We reviewed RDH microbiology records between June 1996 and April 1997 for S. aureus isolates with similar antibiograms to notified cases. We used antibiotic resistance patterns, bacteriophage typing and two molecular typing techniques to subtype implicated isolates. Hospital records were reviewed for admission details and associated costs were estimated.
Fifty-four cluster-related isolates occurred in 47 separate presentations. The peak incidence was in the wet season. The most important risk factor for staphylococcal invasive infection was the presence of skin sores/scabies in 17/54 cases (31%), followed by intravascular line use in 14/54 (26%), open trauma in 11/54 (20%), underlying end stage renal failure and alcoholism each in ten of 54 (18%). The mean admission length was 30 days and antibiotics were given for an average of 23 days. Death due to S. aureus infection occurred in eight of 47 (17%) presentations. S. aureus pneumonia was community acquired in 12/13 patients (92%) and six of 13 (46%) died. Ten of 13 (80%) pneumonia patients had at least one other focus of S. aureus infection. The cost of antibiotics and hospital bed per presentation was approximately $16,000. Presentations with skin sores/scabies cost considerably more ($31,000). No common epidemiologic features were found for community or hospital acquired cases.
Considerable mortality and cost was attributable to cases of S. aureus invasive infection during this cluster; particularly those with community acquired pneumonia or skin sores/scabies. Staphylococcal antibiotic cover should be considered early for unwell patients presenting to hospital with pneumonia and other signs of potential S. aureus infection. It is appropriate to target public health efforts to prevent skin sores and to provide adequate treatment when they occur.
金黄色葡萄球菌侵袭性感染仍然是一种严重疾病，伴有相当高的发病率和死亡率。在皇家达尔文医院（RDH）报告了5例病例后，我们查找了相关病例，确定了其流行病学特征，并试图找出这一明显聚集性病例的源头。
我们查阅了RDH在1996年6月至1997年4月期间的微生物学记录，寻找与报告病例具有相似抗菌谱的金黄色葡萄球菌分离株。我们使用抗生素耐药模式、噬菌体分型和两种分子分型技术对相关分离株进行亚型分析。查阅医院记录以获取入院详细信息，并估算相关费用。
在47次单独就诊中出现了54株与聚集性病例相关的分离株。发病高峰在雨季。金黄色葡萄球菌侵袭性感染最重要的危险因素是17/54例（31%）出现皮肤溃疡/疥疮，其次是14/54例（26%）使用血管内导管，11/54例（20%）有开放性创伤，54例中有10例（18%）存在终末期肾衰竭和酗酒。平均住院时间为30天，抗生素平均使用23天。47次就诊中有8例（17%）因金黄色葡萄球菌感染死亡。13例患者中有12例（92%）的金黄色葡萄球菌肺炎为社区获得性，其中6例（46%）死亡。13例肺炎患者中有10例（80%）至少有一个其他金黄色葡萄球菌感染病灶。每次就诊的抗生素费用和住院床位费用约为16,000美元。出现皮肤溃疡/疥疮的就诊费用要高得多（31,000美元）。社区获得性病例和医院获得性病例未发现共同的流行病学特征。
在这一聚集性病例期间，金黄色葡萄球菌侵袭性感染病例导致了相当高的死亡率和费用；尤其是那些患有社区获得性肺炎或皮肤溃疡/疥疮的病例。对于因肺炎及其他潜在金黄色葡萄球菌感染迹象到医院就诊的不适患者，应尽早考虑使用抗葡萄球菌抗生素。将公共卫生工作目标设定为预防皮肤溃疡并在其发生时提供充分治疗是恰当的。
