Mekontso-Dessap A, Kirsch M, Brun-Buisson C, Loisance D
Service de Chirurgie Thoracique et Cardiovasculaire, Centre Hospitalo-Universitaire Henri Mondor, Créteil, France.
Clin Infect Dis. 2001 Mar 15;32(6):877-83. doi: 10.1086/319355. Epub 2001 Mar 9.
The objective of the study was to compare the outcome of poststernotomy mediastinitis (PSM) caused by methicillin-resistant and methicillin-susceptible Staphylococcus aureus (MRSA and MSSA, respectively). Hospital records of 41 patients with S. aureus PSM who were all treated by closed drainage from 1 April 1996 through 1 February 2000 were reviewed. PSM was caused by MRSA in 15 patients and by MSSA in 26. Follow-up (+/-SD) averaged 12.5+/-14.0 months per patient. Both groups had similar perioperative characteristics. Patients with MRSA PSM had a significantly lower actuarial survival rate than did patients with MSSA PSM (60.0%+/-12.6%, 52.5%+/-3.4%, and 26.3%+/-19.7% versus 84.6%+/-7.1%, 79.0%+/-8.6%, and 79.0%+/-8.65 at 1 month, and at 1 and 3 years, respectively; values are +/- SD; P=.04). PSM-related death and treatment failure were significantly higher in the MRSA group than in the MSSA group (P=.03 and.02, respectively). Logistic regression analysis revealed that MRSA was the only independent risk factor for overall mortality. In conclusion, the clinical outcome of PSM caused by MRSA is poorer than that caused by MSSA.
本研究的目的是比较由耐甲氧西林金黄色葡萄球菌（MRSA）和甲氧西林敏感金黄色葡萄球菌（MSSA）引起的开胸术后纵隔炎（PSM）的结果。回顾了1996年4月1日至2000年2月1日期间41例均采用闭式引流治疗的金黄色葡萄球菌PSM患者的医院记录。15例患者的PSM由MRSA引起，26例由MSSA引起。每位患者的随访时间（±标准差）平均为12.5±14.0个月。两组患者的围手术期特征相似。MRSA引起PSM的患者实际生存率显著低于MSSA引起PSM的患者（1个月时分别为60.0%±12.6%、52.5%±3.4%和26.3%±19.7%，1年和3年时分别为84.6%±7.1%、79.0%±8.6%和79.0%±8.65%；数值为±标准差；P = 0.04）。MRSA组PSM相关死亡和治疗失败显著高于MSSA组（分别为P = 0.03和0.02）。逻辑回归分析显示，MRSA是总体死亡率的唯一独立危险因素。总之，MRSA引起的PSM临床结果比MSSA引起的更差。
