Seybold Ulrich, Halvosa J Sue, White Nancy, Voris Victoria, Ray Susan M, Blumberg Henry M
Division of Infectious Diseases, Medizinische Poliklinik, University Hospital, Ludwig Maximilians University Munich, Munich, Germany.
Pediatrics. 2008 Nov;122(5):1039-46. doi: 10.1542/peds.2007-3161.
The goal of this study was to define more clearly the impact of community-acquired methicillin-resistant Staphylococcus aureus clones (eg, USA300 and USA400) on colonization and infection in infants in intensive care nurseries and potential modes of transmission of community-acquired methicillin-resistant S aureus clones.
Prospective surveillance for methicillin-resistant S aureus colonization and infection was performed among infants in the intensive care nurseries at Grady Memorial Hospital (Atlanta, GA) between 1993 and 2006. Beginning in September 2004, nares surveillance cultures were collected at admission. Methicillin-resistant S aureus isolates were genotyped by using pulsed-field gel electrophoresis and multiplex polymerase chain reaction assays for staphylococcal chromosomal cassette mec gene complex type and Panton-Valentine leukocidin genes. Prevalence of and risk factors for colonization with community-acquired versus health care-associated methicillin-resistant S aureus clones (eg, USA100) were assessed.
Between 1993 and 2006, 130 (3.5%) of 3707 infants were identified to be colonized with methicillin-resistant S aureus. Twelve (1.2%) of 996 admission nares cultures were positive for methicillin-resistant S aureus (since initiation of admission cultures in September 2004). Community-acquired methicillin-resistant S aureus clones were first recovered in 1998; the proportion of methicillin-resistant S aureus clones of community origin increased significantly between 1998 and 2004. Multivariate analysis identified vaginal delivery and maternal smoking, both among infants of mothers receiving systemic antibiotic treatment before delivery, as independent predictors for neonatal colonization with community-acquired methicillin-resistant S aureus. Systemic antibiotic therapy before delivery for nonsmoking mothers delivering through cesarean section and possibly endotracheal intubation were associated with the recovery of health care-associated methicillin-resistant S aureus clones.
Community-acquired methicillin-resistant S aureus clones have emerged as a major cause of methicillin-resistant S aureus colonization in high-risk newborns. Community-acquired methicillin-resistant S aureus recovery was associated with acquisition during birth, whereas health care-associated methicillin-resistant S aureus clones seemed to be transmitted nosocomially.
本研究的目的是更明确社区获得性耐甲氧西林金黄色葡萄球菌克隆株（如USA300和USA400）对重症监护病房婴儿定植和感染的影响，以及社区获得性耐甲氧西林金黄色葡萄球菌克隆株的潜在传播方式。
1993年至2006年期间，在格雷迪纪念医院（佐治亚州亚特兰大）的重症监护病房对婴儿进行耐甲氧西林金黄色葡萄球菌定植和感染的前瞻性监测。从2004年9月开始，在入院时采集鼻腔监测培养物。使用脉冲场凝胶电泳和多重聚合酶链反应分析法对耐甲氧西林金黄色葡萄球菌分离株进行基因分型，以确定葡萄球菌染色体盒式mec基因复合体类型和杀白细胞素基因。评估社区获得性与医疗保健相关的耐甲氧西林金黄色葡萄球菌克隆株（如USA100）定植的患病率和危险因素。
1993年至2006年期间，3707名婴儿中有130名（3.5%）被确定为耐甲氧西林金黄色葡萄球菌定植。996份入院鼻腔培养物中有12份（1.2%）耐甲氧西林金黄色葡萄球菌呈阳性（自2004年9月开始进行入院培养）。社区获得性耐甲氧西林金黄色葡萄球菌克隆株于1998年首次被发现；1998年至2004年期间，社区来源的耐甲氧西林金黄色葡萄球菌克隆株比例显著增加。多变量分析确定，在分娩前接受全身抗生素治疗的母亲所生婴儿中，阴道分娩和母亲吸烟是社区获得性耐甲氧西林金黄色葡萄球菌新生儿定植的独立预测因素。通过剖宫产分娩的不吸烟母亲在分娩前接受全身抗生素治疗以及可能的气管插管与医疗保健相关的耐甲氧西林金黄色葡萄球菌克隆株的检出有关。
社区获得性耐甲氧西林金黄色葡萄球菌克隆株已成为高危新生儿耐甲氧西林金黄色葡萄球菌定植的主要原因。社区获得性耐甲氧西林金黄色葡萄球菌的检出与出生时获得有关，而医疗保健相关的耐甲氧西林金黄色葡萄球菌克隆株似乎是通过医院内传播的。
