Miller Loren G, Diep Binh An
Division of Infectious Diseases, Harbor-University of California-Los Angeles, Torrance, CA, USA.
Clin Infect Dis. 2008 Mar 1;46(5):752-60. doi: 10.1086/526773.
Community-associated methicillin-resistant Staphylococcus aureus (MRSA) infection is increasingly common worldwide and causes considerable morbidity and mortality. Of concern, community-associated MRSA infections are often recurrent and are highly transmissible to close contacts. The traditional tenet of pathogenesis is that MRSA colonization precedes infection. This has prompted persons involved in efforts to prevent community-associated MRSA infection to incorporate the use of intranasal topical antibiotics for nasal decolonization. However, data from outbreaks of community-associated MRSA infection suggest that skin-skin and skin-fomite contact represent important and common alternative routes of acquisition of the infecting strain. Furthermore, strain characteristics of the most successful community-associated MRSA strain, USA300, may contribute to a distinct pathogenesis. As we develop strategies to prevent community-associated MRSA infection, we must reconsider the pathogenesis of S. aureus. Reliance on models of health care-associated MRSA transmission for prevention of community-associated MRSA infection may result in the development of flawed strategies that attenuate our ability to prevent this serious and potentially deadly infection.
社区获得性耐甲氧西林金黄色葡萄球菌（MRSA）感染在全球范围内日益普遍，会导致相当高的发病率和死亡率。令人担忧的是，社区获得性MRSA感染常常复发，并且极易传播给密切接触者。传统的发病机制原则是MRSA定植先于感染。这促使参与预防社区获得性MRSA感染工作的人员采用鼻内局部用抗生素进行鼻腔去定植。然而，社区获得性MRSA感染暴发的数据表明，皮肤与皮肤以及皮肤与污染物的接触是获取感染菌株的重要且常见的替代途径。此外，最成功的社区获得性MRSA菌株USA300的菌株特征可能导致独特的发病机制。在我们制定预防社区获得性MRSA感染的策略时，必须重新考虑金黄色葡萄球菌的发病机制。依赖医疗保健相关MRSA传播模型来预防社区获得性MRSA感染可能会导致制定出有缺陷的策略，削弱我们预防这种严重且可能致命感染的能力。
