Lin Jung-Chung, Yeh Kuo-Ming, Peng Ming-Yieh, Chang Feng-Yee
Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
J Microbiol Immunol Infect. 2004 Feb;37(1):24-8.
The prevalence of community-acquired infection caused by methicillin-resistant Staphylococcus aureus (MRSA) in Taiwan has increased markedly in the past decade. This study investigated the risk factors for acquisition, the clinical features, and the outcome of community-acquired MRSA bacteremia. Data were collected from records of 86 patients with community-acquired S. aureus bacteremia admitted to a tertiary teaching hospital in Taipei from January 1994 to December 1999. MRSA accounted for 26% (22/86) of isolated pathogens. Over 90% of patients with S. aureus bacteremia had one or more underlying diseases. Significantly more patients with MRSA bacteremia [vs methicillin-susceptible S. aureus (MSSA) bacteremia] had congenital and valvular heart diseases (18% vs 0%, p=0.004), an initial presentation of acute respiratory failure (32% vs 11%, p=0.022), an implant as a portal of entry (9% vs 0%, p=0.014), and mortality (41% vs 20%, p=0.05). Acute Physiology and Chronic Health Evaluation (APACHE) III score was significantly higher in patients who died than in patients who survived in both the MRSA and MSSA bacteremia groups. Inappropriate treatment was more frequent in patients with MRSA bacteremia than in MSSA bacteremia. When a Gram-positive coccemia is initially noted in a patient with high APACHE III score and/or acute respiratory failure, early and aggressive treatment including glycopeptide should be considered.
在过去十年中，台湾地区耐甲氧西林金黄色葡萄球菌（MRSA）引起的社区获得性感染患病率显著上升。本研究调查了社区获得性MRSA菌血症的感染危险因素、临床特征及转归。收集了1994年1月至1999年12月在台北一家三级教学医院住院的86例社区获得性金黄色葡萄球菌菌血症患者的记录资料。MRSA占分离病原体的26%（22/86）。超过90%的金黄色葡萄球菌菌血症患者有一种或多种基础疾病。与甲氧西林敏感金黄色葡萄球菌（MSSA）菌血症患者相比，MRSA菌血症患者有先天性和瓣膜性心脏病的比例显著更高（18%对0%，p = 0.004），急性呼吸衰竭的初始表现比例更高（32%对11%，p = 0.022），有植入物作为感染入口的比例更高（9%对0%，p = 0.014），死亡率更高（41%对20%，p = 0.05）。在MRSA和MSSA菌血症组中，死亡患者的急性生理与慢性健康状况评估（APACHE）III评分均显著高于存活患者。MRSA菌血症患者不恰当治疗的情况比MSSA菌血症患者更常见。当在APACHE III评分高和/或有急性呼吸衰竭的患者中最初发现革兰阳性球菌血症时，应考虑早期积极治疗，包括使用糖肽类药物。
