鼻腔携带者与非携带者发生医院获得性金黄色葡萄球菌菌血症的风险及结局

Risk and outcome of nosocomial Staphylococcus aureus bacteraemia in nasal carriers versus non-carriers.

作者信息

Wertheim Heiman F L, Vos Margreet C, Ott Alewijn, van Belkum Alex, Voss Andreas, Kluytmans Jan A J W, van Keulen Peter H J, Vandenbroucke-Grauls Christina M J E, Meester Marlene H M, Verbrugh Henri A

机构信息

Erasmus MC, University Medical Centre, Rotterdam, Department of Medical Microbiology and Infectious Diseases, Dr Molewaterplein 40, 3015 GD Rotterdam, Netherlands.

出版信息

Lancet. 2004;364(9435):703-5. doi: 10.1016/S0140-6736(04)16897-9.

DOI:10.1016/S0140-6736(04)16897-9

PMID:15325835

Abstract

Staphylococcus aureus is the second most frequent cause of nosocomial blood infections. We screened 14008 non-bacteraemic, non-surgical patients for S aureus nasal carriage at admission, and monitored them for development of bacteraemia. Nosocomial S aureus bacteraemia was three times more frequent in S aureus carriers (40/3420, 1.2%) than in non-carriers (41/10588, 0.4%; relative risk 3.0, 95% CI 2.0-4.7). However, in bacteraemic patients, all-cause mortality was significantly higher in non-carriers (19/41, 46%) than in carriers (seven/40, 18%, p=0.005). Additionally, S aureus bacteraemia-related death was significantly higher in non-carriers than in carriers (13/41 [32%] vs three/40 [8%], p=0.006). S aureus nasal carriers and non-carriers differ significantly in risk and outcome of nosocomial S aureus bacteraemia. Genotyping revealed that 80% of strains causing bacteraemia in carriers were endogenous.

摘要

金黄色葡萄球菌是医院获得性血液感染的第二大常见病因。我们在14008例非菌血症、非手术患者入院时筛查了金黄色葡萄球菌鼻腔携带情况，并对他们发生菌血症的情况进行监测。金黄色葡萄球菌携带者发生医院获得性金黄色葡萄球菌菌血症的频率（40/3420，1.2%）是非携带者（41/10588，0.4%；相对风险3.0，95%CI 2.0 - 4.7）的3倍。然而，在菌血症患者中，非携带者的全因死亡率（19/41，46%）显著高于携带者（7/40，18%，p = 0.005）。此外，非携带者中与金黄色葡萄球菌菌血症相关的死亡率显著高于携带者（13/41 [32%] 对3/40 [8%]，p = 0.006）。金黄色葡萄球菌鼻腔携带者和非携带者在医院获得性金黄色葡萄球菌菌血症的风险和结局方面存在显著差异。基因分型显示，携带者中引起菌血症的菌株80%为内源性。