2002年至2005年，德国一个村庄通过严格的去定植措施成功终止了由lukS-lukF阳性、甲氧西林敏感金黄色葡萄球菌引起的疖病暴发。

Successful termination of a furunculosis outbreak due to lukS-lukF-positive, methicillin-susceptible Staphylococcus aureus in a German village by stringent decolonization, 2002-2005.

作者信息

Wiese-Posselt Miriam, Heuck Dagmar, Draeger Andreas, Mielke Martin, Witte Wolfgang, Ammon Andrea, Hamouda Osamah

机构信息

Department for Infectious Disease Epidemiology, Robert Koch-Institut, Berlin, Germany.

出版信息

Clin Infect Dis. 2007 Jun 1;44(11):e88-95. doi: 10.1086/517503. Epub 2007 Apr 25.

DOI:10.1086/517503

PMID:17479931

Abstract

BACKGROUND

Skin infections due to Staphylococcus aureus have recently become a public concern, mainly because of emerging resistance against widely used antibiotics and specific virulence determinants. Strains harboring the lukS-lukF gene (which codes for Panton-Valentine leukocidin) are frequently associated with severe furunculosis. Generally applicable strategies for the control of community outbreaks of furunculosis have not been defined.

METHODS

We report the investigation and successful termination of an outbreak of furunculosis due to lukS-lukF-positive S. aureus in a German village (n=144). Nasal swab specimens were obtained from village residents. A retrospective cohort study was conducted. Nasally colonized persons, persons who had current furuncles or who had experienced relapsing furuncles since 2002, and their family members underwent stringent decolonization measures using mupirocin nasal ointment and disinfecting wash solution. Multiple nasal swab specimens were obtained to monitor the long-term outcome of decolonization measures.

RESULTS

From January 1998 through December 2004, 42 cases and 59 relapses of furunculosis were identified by active case finding. Of 140 participants tested, 51 (36%) were found to be nasally colonized with S. aureus. In 9 participants, the strain was positive for lukS-lukF. No methicillin resistance was detected. Risk of furunculosis was associated with contact with case patients (relative risk, 6.8; 95% confidence interval, 3.2-14.3) and nasal colonization with a lukS-lukF-positive strain of S. aureus (relative risk, 3.6; 95% confidence interval, 2.3-5.9). Passive surveillance implemented in January 2005 did not detect any case of lukS-lukF-positive, S. aureus-associated furuncles in this village.

CONCLUSION

This report describes a successful strategy for terminating the transmission of epidemic strains of S. aureus among a nonhospitalized population.

摘要

背景

金黄色葡萄球菌引起的皮肤感染近来已成为公众关注的问题，主要是因为对广泛使用的抗生素出现耐药性以及特定的毒力决定因素。携带lukS - lukF基因（编码杀白细胞素）的菌株常与严重的疖病相关。控制社区疖病暴发的普遍适用策略尚未明确。

方法

我们报告了德国一个村庄（n = 144）因lukS - lukF阳性金黄色葡萄球菌引起的疖病暴发的调查及成功控制情况。从村庄居民中采集鼻拭子标本。进行了一项回顾性队列研究。鼻腔定植者、患有当前疖肿者或自2002年以来经历复发性疖肿者及其家庭成员使用莫匹罗星鼻软膏和消毒洗涤液进行严格的去定植措施。采集多个鼻拭子标本以监测去定植措施的长期效果。

结果

从1998年1月至2004年12月，通过主动病例发现确定了42例疖病病例和59例复发。在140名接受检测的参与者中，51人（36%）被发现鼻腔定植有金黄色葡萄球菌。在9名参与者中，该菌株lukS - lukF呈阳性。未检测到耐甲氧西林情况。疖病风险与接触病例患者相关（相对风险，6.8；95%置信区间，3.2 - 14.3）以及鼻腔定植lukS - lukF阳性金黄色葡萄球菌菌株相关（相对风险，3.6；95%置信区间，2.3 - 5.9）。2005年1月实施的被动监测未在该村庄检测到任何lukS - lukF阳性、与金黄色葡萄球菌相关的疖病病例。