Graffunder Eileen M, Venezia Richard A
Department of Epidemiology MC-45, Albany Medical Center Hospital, 43 New Scotland Avenue, Albany, NY 12208, USA.
J Antimicrob Chemother. 2002 Jun;49(6):999-1005. doi: 10.1093/jac/dkf009.
Methicillin-resistant Staphylococcus aureus (MRSA) is a major nosocomial pathogen worldwide. To investigate an association between antimicrobial use and MRSA, a case control study of 121 patients infected with MRSA compared with 123 patients infected with methicillin-susceptible S. aureus (MSSA) was carried out. Antimicrobial use was analysed by three different logistic regression models: all beta-lactam antibiotics, beta-lactam antibiotics grouped in classes and antimicrobial use in grammes. Patients infected with MRSA tended to have more co-morbidities, longer lengths of stay (LOS) and greater exposure to antibiotics than MSSA-infected patients. Multivariate analysis identified levofloxacin [odds ratio (OR) 8.01], macrolides (OR 4.06), previous hospitalization (OR 1.95), enteral feedings (OR 2.55), surgery (OR 2.24) and LOS before culture (OR 1.03) as independently associated with MRSA infection. All models were concordant with the exception of macrolides, which were not significant based on the number of grammes administered. There were no significant differences in the types of infection or the attributed mortality in either group. MRSA-infected patients had a significantly longer LOS before infection [18.8 +/- 18.2 compared with 8.4 +/- 6.9 (P < 0.001)] and a significantly longer post-diagnosis LOS [27.8 +/- 32.9 compared with 18.6 +/- 21 (P = 0.01)] than MSSA-infected patients.
耐甲氧西林金黄色葡萄球菌（MRSA）是全球主要的医院病原体。为了研究抗菌药物使用与MRSA之间的关联，开展了一项病例对照研究，将121例感染MRSA的患者与123例感染甲氧西林敏感金黄色葡萄球菌（MSSA）的患者进行比较。通过三种不同的逻辑回归模型分析抗菌药物使用情况：所有β-内酰胺类抗生素、按类别分组的β-内酰胺类抗生素以及以克为单位的抗菌药物使用量。与感染MSSA的患者相比，感染MRSA的患者往往合并症更多、住院时间更长（LOS）且接触抗生素的机会更多。多变量分析确定左氧氟沙星[比值比（OR）8.01]、大环内酯类（OR 4.06）、既往住院史（OR 1.95）、肠内喂养（OR 2.55）、手术（OR 2.24）以及培养前的住院时间（OR 1.03）与MRSA感染独立相关。除大环内酯类外，所有模型结果一致，基于给药克数计算，大环内酯类无统计学意义。两组在感染类型或归因死亡率方面无显著差异。与感染MSSA的患者相比，感染MRSA的患者在感染前的住院时间显著更长[18.8±18.2天对比8.4±6.9天（P<0.001）]，诊断后的住院时间也显著更长[27.8±32.9天对比18.6±21天（P = 0.01）]。
