David Michael Z, Mennella Connie, Mansour Mohamed, Boyle-Vavra Susan, Daum Robert S
Section of Infectious Diseases, Department of Medicine, The University of Chicago, 5841 S. Maryland Ave., MC 6054, Chicago, IL 60637, USA.
J Clin Microbiol. 2008 Oct;46(10):3222-7. doi: 10.1128/JCM.01423-08. Epub 2008 Aug 6.
In the 1990s, community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) strains emerged as pathogens outside of the health care environment. Epidemic foci of CA-MRSA infections were reported in jails and prisons, but risk factors for MRSA infection there are not known. All skin and soft tissue infections (SSTIs) cultured in the Cook County Jail in March 2004 to August 2005 were reviewed. Demographic and clinical risk factors were compared among patients with methicillin-susceptible S. aureus (MSSA) SSTIs and those with MRSA SSTIs. Antibiotic susceptibilities were recorded, and we performed multilocus sequence typing on a sample of MRSA isolates. There were 378 SSTIs from different patients requiring culture, of which 240 (63.5%) were of MRSA and 43 (11.4%) were of MSSA; 84.8% of S. aureus isolates were MRSA. MRSA- and MSSA-infected patients were similar with regard to age, gender, ethnicity, previous exposure to the jail, and comorbidities. In the 12 months prior to the index culture, MRSA patients were more likely to have received a beta-lactam antibiotic (25% versus 9%; P = 0.02). Among 26 MRSA strains, 24 (92%) had the sequence type 8 (ST8) genotype. Within 6 months, 14% (95% confidence interval, 8.7% to 22.3%) of MRSA SSTI patients in the jail had a recurrent SSTI compared with 8.8% (95% confidence interval, 2.1% to 32.6%) of MSSA SSTI patients (P = 0.004). MRSA is the predominant cause of SSTIs requiring culture in the jail. Few risk factors differentiated MRSA from MSSA SSTIs, and detainee patients with MRSA SSTIs are at high risk for recurrent SSTIs.
20世纪90年代，社区获得性耐甲氧西林金黄色葡萄球菌（CA-MRSA）菌株作为医疗保健环境之外的病原体出现。在监狱中报告了CA-MRSA感染的流行病灶，但那里耐甲氧西林金黄色葡萄球菌感染的危险因素尚不清楚。对2004年3月至2005年8月在库克县监狱培养的所有皮肤和软组织感染（SSTI）进行了回顾。比较了甲氧西林敏感金黄色葡萄球菌（MSSA）SSTI患者和耐甲氧西林金黄色葡萄球菌SSTI患者的人口统计学和临床危险因素。记录了抗生素敏感性，并对耐甲氧西林金黄色葡萄球菌分离株的样本进行了多位点序列分型。有378例来自不同患者的SSTI需要培养，其中240例（63.5%）为耐甲氧西林金黄色葡萄球菌，43例（11.4%）为甲氧西林敏感金黄色葡萄球菌；84.8%的金黄色葡萄球菌分离株为耐甲氧西林金黄色葡萄球菌。耐甲氧西林金黄色葡萄球菌和甲氧西林敏感金黄色葡萄球菌感染患者在年龄、性别、种族、以前接触监狱情况和合并症方面相似。在索引培养前的12个月内，耐甲氧西林金黄色葡萄球菌患者更有可能接受β-内酰胺类抗生素治疗（25%对9%；P = 0.02）。在26株耐甲氧西林金黄色葡萄球菌菌株中，24株（92%）具有序列类型8（ST8）基因型。在6个月内，监狱中14%（95%置信区间，8.7%至22.3%）的耐甲氧西林金黄色葡萄球菌SSTI患者出现复发性SSTI，而甲氧西林敏感金黄色葡萄球菌SSTI患者为8.8%（95%置信区间，2.1%至32.6%）（P = 0.004）。耐甲氧西林金黄色葡萄球菌是监狱中需要培养的SSTI的主要原因。区分耐甲氧西林金黄色葡萄球菌和甲氧西林敏感金黄色葡萄球菌SSTI的危险因素很少，耐甲氧西林金黄色葡萄球菌SSTI的被拘留患者有很高的复发性SSTI风险。
