Fridkin Scott K, Hageman Jeffrey C, Morrison Melissa, Sanza Laurie Thomson, Como-Sabetti Kathryn, Jernigan John A, Harriman Kathleen, Harrison Lee H, Lynfield Ruth, Farley Monica M
Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
N Engl J Med. 2005 Apr 7;352(14):1436-44. doi: 10.1056/NEJMoa043252.
Methicillin-resistant Staphylococcus aureus (MRSA) infection has emerged in patients who do not have the established risk factors. The national burden and clinical effect of this novel presentation of MRSA disease are unclear.
We evaluated MRSA infections in patients identified from population-based surveillance in Baltimore and Atlanta and from hospital-laboratory-based sentinel surveillance of 12 hospitals in Minnesota. Information was obtained by interviewing patients and by reviewing their medical records. Infections were classified as community-associated [correction] MRSA disease if no established risk factors were identified.
From 2001 through 2002, 1647 cases of community-associated [correction] MRSA infection were reported, representing between 8 and 20 percent of all MRSA isolates. The annual disease incidence varied according to site (25.7 cases per 100,000 population in Atlanta vs. 18.0 per 100,000 in Baltimore) and was significantly higher among persons less than two years old than among those who were two years of age or older (relative risk, 1.51; 95 percent confidence interval, 1.19 to 1.92) and among blacks than among whites in Atlanta (age-adjusted relative risk, 2.74; 95 percent confidence interval, 2.44 to 3.07). Six percent of cases were invasive, and 77 percent involved skin and soft tissue. The infecting strain of MRSA was often (73 percent) resistant to prescribed antimicrobial agents. Among patients with skin or soft-tissue infections, therapy to which the infecting strain was resistant did not appear to be associated with adverse patient-reported outcomes. Overall, 23 percent of patients were hospitalized for the MRSA infection.
Community-associated MRSA infections are now a common and serious problem. These infections usually involve the skin, especially among children, and hospitalization is common.
耐甲氧西林金黄色葡萄球菌（MRSA）感染已出现在无既定危险因素的患者中。这种新型MRSA疾病的全国负担和临床影响尚不清楚。
我们评估了在巴尔的摩和亚特兰大基于人群的监测以及明尼苏达州12家医院基于医院实验室的哨点监测中识别出的患者的MRSA感染情况。通过采访患者和查阅他们的病历获取信息。如果未识别出既定危险因素，则将感染分类为社区相关性MRSA疾病。
2001年至2002年期间，报告了1647例社区相关性MRSA感染病例，占所有MRSA分离株的8％至20％。年度疾病发病率因地点而异（亚特兰大每10万人口中有25.7例，巴尔的摩每10万人口中有18.0例），两岁以下人群中的发病率明显高于两岁及以上人群（相对风险为1.51；95％置信区间为1.19至1.92），并且亚特兰大黑人中的发病率高于白人（年龄调整后的相对风险为2.74；95％置信区间为2.44至3.07）。6％的病例为侵袭性感染，77％涉及皮肤和软组织。MRSA感染菌株通常（73％）对规定的抗菌药物耐药。在皮肤或软组织感染患者中，感染菌株耐药的治疗似乎与患者报告的不良结局无关。总体而言，23％的患者因MRSA感染住院。
社区相关性MRSA感染现在是一个常见且严重的问题。这些感染通常累及皮肤，尤其是儿童，并且住院很常见。
