Johnson Peter N, Rapp Robert P, Nelson Christopher T, Butler J S, Overman Sue, Kuhn Robert J
University of Kentucky Chandler Medical Center, Lexington, KY, USA.
Ann Pharmacother. 2007 Sep;41(9):1361-7. doi: 10.1345/aph.1K118. Epub 2007 Jul 24.
Limited data exist concerning characteristics of community-acquired Staphylococcus aureus infections (CA-SAI) in central and eastern Kentucky.
To describe the incidence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections from January 1, 2004 through December 31, 2005, compare the number of CA-MRSA infections between years, and contrast treatment interventions and antibiotic susceptibility patterns of CA-SAI.
A concurrent and retrospective study was conducted in 125 patients less than 18 years of age with CA-SAI admitted to the hospital/clinic based on criteria from the Centers for Disease Control and Prevention. Data on demographics, length of stay, antibiotic therapy, and antibiotic susceptibilities were collected.
Seventy patients were included for analysis (CA-MRSA, n = 51; community-acquired methicillin-susceptible S. aureus [CA-MSSA], n = 19). No statistically significant differences were noted between the number of CA-MRSA infections and the total CA-SAI (9/15 in 2004 vs 42/55 in 2005; p = 0.15). Approximately 75% of patients with CA-SAI were admitted to the hospital with no significant difference in length of stay. Ninety percent of CA-SAI were skin and soft tissue infections. There was a significant difference between groups with cutaneous abscesses (CA-MRSA, n = 37 vs CA-MSSA, n = 6; p = 0.002). Greater than 95% of all isolates were susceptible to vancomycin and trimethoprim/sulfamethoxazole. Half of CA-MRSA patients received inappropriate antibiotic therapy with beta-lactam antibiotics or clindamycin without confirmatory disk diffusion test. Twenty-five (49%) patients with CA-MRSA received surgical debridement (S/D) and/or incision and drainage (I/D) with concomitant antibiotic therapy. Four patients with CA-MRSA were rehospitalized for subsequent infections; all 4 received appropriate antibiotic therapy.
A noticeable increase in CA-MRSA infections with cutaneous abscess between 2004 and 2005 was noted. In patients receiving inappropriate antibiotic therapy, treatment success was attributed to concomitant S/D and I/D. Further analysis should focus on the impact of antibiotic therapy alone or in combination with S/D and I/D on the incidence of subsequent CA-MRSA infections.
关于肯塔基州中部和东部社区获得性金黄色葡萄球菌感染（CA-SAI）的特征，现有数据有限。
描述2004年1月1日至2005年12月31日社区获得性耐甲氧西林金黄色葡萄球菌（CA-MRSA）感染的发生率，比较不同年份CA-MRSA感染的数量，并对比CA-SAI的治疗干预措施和抗生素敏感性模式。
对125名18岁以下符合美国疾病控制与预防中心标准的因CA-SAI入院/就诊的患者进行了一项同期回顾性研究。收集了人口统计学、住院时间、抗生素治疗及抗生素敏感性的数据。
70名患者纳入分析（CA-MRSA，n = 51；社区获得性甲氧西林敏感金黄色葡萄球菌[CA-MSSA]，n = 19）。CA-MRSA感染数量与CA-SAI总数之间无统计学显著差异（2004年9/15 vs 2005年42/55；p = 0.15）。约75%的CA-SAI患者入院，住院时间无显著差异。90%的CA-SAI为皮肤和软组织感染。皮肤脓肿组之间存在显著差异（CA-MRSA，n = 37 vs CA-MSSA，n = 6；p = 0.002）。所有分离株中超过95%对万古霉素和甲氧苄啶/磺胺甲恶唑敏感。一半的CA-MRSA患者在未进行确认性纸片扩散试验的情况下接受了不恰当的β-内酰胺类抗生素或克林霉素治疗。25名（49%）CA-MRSA患者接受了外科清创术（S/D）和/或切开引流术（I/D）并同时接受抗生素治疗。4名CA-MRSA患者因后续感染再次入院；所有4名患者均接受了恰当的抗生素治疗。
2004年至2005年期间，CA-MRSA皮肤脓肿感染显著增加。在接受不恰当抗生素治疗的患者中，治疗成功归因于同时进行的S/D和I/D。进一步分析应聚焦于单独的抗生素治疗或联合S/D和I/D对后续CA-MRSA感染发生率的影响。
