Kaplan Sheldon L, Hulten Kristina G, Gonzalez Blanca E, Hammerman Wendy A, Lamberth Linda, Versalovic James, Mason Edward O
Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.
Clin Infect Dis. 2005 Jun 15;40(12):1785-91. doi: 10.1086/430312. Epub 2005 May 6.
Methicillin-resistant Staphylococcus aureus (MRSA) isolates are increasingly frequent causes of skin and soft-tissue infections or invasive infections in many communities.
Prospective surveillance for community-acquired S. aureus infections at Texas Children's Hospital was initiated on 1 August 2001. Infections meeting the definition of community-acquired were identified. Demographic and clinical data were collected. Antibiotic susceptibilities, including inducible resistance to macrolide, lincosamide, and streptogramin B (MLSB), were determined in the clinical microbiology laboratory with the methodology of the NCCLS. All data were entered into a computer database. Data were analyzed by chi2 tests.
From 1 August 2001 to 31 July 2004, the percentage of community-acquired S. aureus isolates that were methicillin resistant increased from 71.5% (551 of 771 isolates) in year 1 to 76.4% (1193 of 1562 isolates) in year 3 (P = .008). The number of both community-acquired MRSA (CA-MSRA) isolates and community-acquired methicillin-susceptible S. aureus (CA-MSSA) isolates increased yearly, but the rate of increase was greater for the CA-MRSA isolates. Among the CA-MRSA isolates, 2542 (95.6%) were obtained from children with skin and soft-tissue infections, and 117 (4.4%) were obtained from children with invasive infections. Overall, 62% of children with CA-MRSA isolates and 53% of children with CA-MSSA isolates were admitted to the hospital (P = .0001). The rate of clindamycin resistance increased significantly for both CA-MRSA isolates (P = .003) and CA-MSSA isolates (P = .00003) over the 3 years. MLSB inducible resistance was found in 27 (44%) of 62 clindamycin-resistant CA-MSSA isolates, compared with 6 (4.5%) of 132 clindamycin-resistant CA-MRSA isolates (P < .000001).
CA-MRSA isolates account for an increasing percentage and number of infections at Texas Children's Hospital. Clindamycin resistance increased among community-acquired S. aureus isolates. Community surveillance of community-acquired S. aureus infections is critical to determine the appropriate empiric antibiotic treatment for either local or invasive infections.
耐甲氧西林金黄色葡萄球菌（MRSA）菌株日益成为许多社区皮肤和软组织感染或侵袭性感染的常见病因。
2001年8月1日开始对德克萨斯儿童医院社区获得性金黄色葡萄球菌感染进行前瞻性监测。确定符合社区获得性定义的感染。收集人口统计学和临床数据。在临床微生物实验室采用美国国家临床实验室标准化委员会（NCCLS）的方法测定抗生素敏感性，包括对大环内酯类、林可酰胺类和链阳菌素B（MLSB）的诱导耐药性。所有数据输入计算机数据库。采用卡方检验进行数据分析。
2001年8月1日至2004年7月31日，社区获得性金黄色葡萄球菌分离株中耐甲氧西林的比例从第1年的71.5%（771株中的551株）增至第3年的76.4%（1562株中的1193株）（P = 0.008）。社区获得性MRSA（CA-MRSA）分离株和社区获得性甲氧西林敏感金黄色葡萄球菌（CA-MSSA）分离株的数量均逐年增加，但CA-MRSA分离株的增加速率更大。在CA-MRSA分离株中，2542株（95.6%）来自皮肤和软组织感染患儿，117株（4.4%）来自侵袭性感染患儿。总体而言，CA-MRSA分离株患儿中有62%、CA-MSSA分离株患儿中有53%住院治疗（P = 0.0001）。3年间，CA-MRSA分离株（P = 0.003）和CA-MSSA分离株（P = 0.00003）的克林霉素耐药率均显著增加。在62株克林霉素耐药的CA-MSSA分离株中，27株（44%）存在MLSB诱导耐药，而在132株克林霉素耐药的CA-MRSA分离株中，有6株（4.5%）存在MLSB诱导耐药（P < 0.000001）。
在德克萨斯儿童医院，CA-MRSA分离株所致感染的比例和数量不断增加。社区获得性金黄色葡萄球菌分离株的克林霉素耐药性增加。对社区获得性金黄色葡萄球菌感染进行社区监测对于确定针对局部或侵袭性感染的合适经验性抗生素治疗至关重要。
