Robinson J O, Pearson J C, Christiansen K J, Coombs G W, Murray R J
Department of Microbiology and Infectious Diseases, Royal Perth Hospital, Perth, Western Australia.
Eur J Clin Microbiol Infect Dis. 2009 Apr;28(4):353-61. doi: 10.1007/s10096-008-0632-1. Epub 2008 Oct 11.
The objective was to compare the epidemiology and outcome of healthcare- (HA-) and community-associated (CA-) MRSA bacteraemia. A 10-year retrospective study of MRSA bacteraemia was carried out. Episodes were classified according to established criteria. Molecular typing was performed on a subset of isolates. Of 197 MRSA bacteraemia episodes, 178 (90.4%) were classified as HA-MRSA and 19 (9.6%) as CA-MRSA. All-cause 7- and 30-day mortality rates were similar in the HA and CA-MRSA bacteraemia groups; however, 1-year mortality was higher in the HA-MRSA bacteraemia group (48.3% vs 21.1% [p = 0.023]). Thirty-day all-cause mortality was significantly lower if empiric antimicrobial therapy included agent(s) to which the isolate tested susceptible, compared with patients receiving "inactive" therapy (19% vs 35.1% [p = 0.011]). The majority of MRSA bacteraemia episodes were caused by clones known to circulate in the community. All-cause mortality is as high in HA- as in CA-MRSA bacteraemia. Thirty-day mortality was significantly reduced if the patient received an antibiotic with activity against the MRSA isolate.
目的是比较医疗保健相关（HA-）和社区相关（CA-）耐甲氧西林金黄色葡萄球菌（MRSA）菌血症的流行病学及转归。对MRSA菌血症进行了一项为期10年的回顾性研究。根据既定标准对病例进行分类。对一部分分离株进行了分子分型。在197例MRSA菌血症病例中，178例（90.4%）被分类为HA-MRSA，19例（9.6%）为CA-MRSA。HA-MRSA和CA-MRSA菌血症组的全因7天和30天死亡率相似；然而，HA-MRSA菌血症组的1年死亡率更高（48.3%对21.1%[p = 0.023]）。与接受“无效”治疗的患者相比，如果经验性抗菌治疗包括分离株对其敏感的药物，则30天全因死亡率显著降低（19%对35.1%[p = 0.011]）。大多数MRSA菌血症病例由已知在社区传播的克隆株引起。HA-MRSA菌血症的全因死亡率与CA-MRSA菌血症一样高。如果患者接受了对MRSA分离株有活性的抗生素治疗，30天死亡率会显著降低。
