Estivariz Concepcion F, Park Sarah Y, Hageman Jeffrey C, Dvorin Jeffrey, Melish Marian M, Arpon Rose, Coon Pat, Slavish Susan, Kim Mary, McDougal Linda K, Jensen Bette, McAllister Sigrid, Lonsway David, Killgore George, Effler Paul E, Jernigan Daniel B
Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, US Department of Health and Human Services, Atlanta, GA 30333, USA.
J Infect. 2007 Apr;54(4):349-57. doi: 10.1016/j.jinf.2006.08.002. Epub 2006 Sep 20.
We conducted a retrospective study to determine trends and characteristics of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in Hawaii.
We reviewed medical records of patients with MRSA infections during July 2001-June 2003 in four healthcare facilities. A case was defined as a patient with MRSA infection (colonization excluded), diagnosed in ambulatory settings or < or = 48 h after hospitalization, without previous MRSA or healthcare risk factors. Pulsed-field gel electrophoresis (PFGE) and typing of resistance and toxin genes was performed in 40 MRSA isolates.
CA-MRSA infections increased from 28 (23% of MRSA infections) to 65 (32%) per quarter over the 2-year period (P<0.05). Pacific islanders accounted for 51% of 389 case-patients, but only 24% of the Hawaii population. In the pediatric hospital, Pacific Islanders represented 76% of 90 case-patients versus 35% of the hospital population. Hospital admission, required for 40% (154/389), was associated with prior antimicrobial treatment (P<0.01). The staphylococcal cassette chromosome mec type IV was detected in 38/40 isolates; 31 isolates carried Panton-Valentine leukocidin genes and 22 belonged to the same staphylococcal lineage.
In Hawaii, prevention strategies for CA-MRSA infections should focus on Pacific Islanders. CA-MRSA infections in Hawaii appear to be related to strains causing disease throughout the United States.
我们开展了一项回顾性研究，以确定夏威夷社区获得性耐甲氧西林金黄色葡萄球菌（CA-MRSA）的趋势和特征。
我们回顾了2001年7月至2003年6月期间四家医疗机构中耐甲氧西林金黄色葡萄球菌感染患者的病历。病例定义为在门诊环境中诊断出的耐甲氧西林金黄色葡萄球菌感染患者（排除定植），或住院后≤48小时，且无既往耐甲氧西林金黄色葡萄球菌或医疗风险因素。对40株耐甲氧西林金黄色葡萄球菌分离株进行了脉冲场凝胶电泳（PFGE）以及耐药和毒素基因分型。
在两年期间，CA-MRSA感染从每季度28例（占耐甲氧西林金黄色葡萄球菌感染的23%）增加到65例（占32%）（P<0.05）。在389例病例患者中，太平洋岛民占51%，但仅占夏威夷人口的24%。在儿科医院，90例病例患者中太平洋岛民占76%，而占医院总人口的35%。40%（154/389）的患者需要住院治疗，这与先前的抗菌治疗有关（P<0.01）。在40株分离株中检测到葡萄球菌盒式染色体mec IV型；31株携带杀白细胞素基因，22株属于同一葡萄球菌谱系。
在夏威夷，CA-MRSA感染的预防策略应侧重于太平洋岛民。夏威夷的CA-MRSA感染似乎与在美国各地引起疾病的菌株有关。
