Clancy Megan J, Graepler Amy, Breese Peter E, Price Connie S, Burman William J
Department of Internal Medicine, University of Colorado Health Sciences Center, Denver, CO. USA.
South Med J. 2005 Nov;98(11):1069-75. doi: 10.1097/01.smj.0000184800.83171.f7.
Increasing rates of methicillin resistance among out-patient Staphylococcus aureus infections led us to assess the epidemiology and outcome of a local outbreak.
A retrospective cohort study of outpatient skin and soft tissue infections due to S aureus in 2003.
From 2002 to mid-2004, the percentage of outpatient S aureus isolates resistant to methicillin increased from 6 to 45%. In multivariate analysis, only male sex and age greater than 18 years were associated with methicillin resistance. Methicillin resistance was common (>15%) among isolates from patients in nearly all subgroups evaluated. Pulsed field gel electrophoresis showed isolates related to USA 300, but methicillin-resistant strains had unusually high rates of quinolone resistance.
A single strain of methicillin-resistant S aureus is responsible for the increase in skin infections in outpatients without traditional risk factors for infection with an antibiotic-resistant strain. In areas with high rates of methicillin-resistant S aureus outpatient infections, we recommend non-beta-lactam antibiotics for initial treatment of skin and soft tissue infections.
门诊金黄色葡萄球菌感染中耐甲氧西林率不断上升，促使我们评估一次局部暴发的流行病学情况及结局。
对2003年门诊因金黄色葡萄球菌引起的皮肤和软组织感染进行一项回顾性队列研究。
从2002年到2004年年中，门诊分离出的耐甲氧西林金黄色葡萄球菌百分比从6%增至45%。多变量分析显示，仅男性和年龄大于18岁与耐甲氧西林有关。在几乎所有评估的亚组患者的分离菌株中，耐甲氧西林情况常见（>15%）。脉冲场凝胶电泳显示分离菌株与USA 300有关，但耐甲氧西林菌株的喹诺酮耐药率异常高。
单一菌株的耐甲氧西林金黄色葡萄球菌导致了无传统耐药菌株感染危险因素的门诊患者皮肤感染增加。在耐甲氧西林金黄色葡萄球菌门诊感染率高的地区，我们建议用非β-内酰胺类抗生素初始治疗皮肤和软组织感染。
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