热带地区的金黄色葡萄球菌菌血症：患者预后及抗生素耐药性的影响
Staphylococcus aureus bacteraemia in a tropical setting: patient outcome and impact of antibiotic resistance.
作者信息
Nickerson Emma K, Hongsuwan Maliwan, Limmathurotsakul Direk, Wuthiekanun Vanaporn, Shah Krupal R, Srisomang Pramot, Mahavanakul Weera, Wacharaprechasgul Therapon, Fowler Vance G, West T Eoin, Teerawatanasuk Nitaya, Becher Harald, White Nicholas J, Chierakul Wirongrong, Day Nicholas P, Peacock Sharon J
机构信息
Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand.
出版信息
PLoS One. 2009;4(1):e4308. doi: 10.1371/journal.pone.0004308. Epub 2009 Jan 30.
BACKGROUND
Most information on invasive Staphylococcus aureus infections comes from temperate countries. There are considerable knowledge gaps in epidemiology, treatment, drug resistance and outcome of invasive S. aureus infection in the tropics.
METHODS
A prospective, observational study of S. aureus bacteraemia was conducted in a 1000-bed regional hospital in northeast Thailand over 1 year. Detailed clinical data were collected and final outcomes determined at 12 weeks, and correlated with antimicrobial susceptibility profiles of infecting isolates.
PRINCIPAL FINDINGS
Ninety-eight patients with S. aureus bacteraemia were recruited. The range of clinical manifestations was similar to that reported from temperate countries. The prevalence of endocarditis was 14%. The disease burden was highest at both extremes of age, whilst mortality increased with age. The all-cause mortality rate was 52%, with a mortality attributable to S. aureus of 44%. Methicillin-resistant S. aureus (MRSA) was responsible for 28% of infections, all of which were healthcare-associated. Mortality rates for MRSA and methicillin-susceptible S. aureus (MSSA) were 67% (18/27) and 46% (33/71), respectively (p = 0.11). MRSA isolates were multidrug resistant. Only vancomycin or fusidic acid would be suitable as empirical treatment options for suspected MRSA infection.
CONCLUSIONS
S. aureus is a significant pathogen in northeast Thailand, with comparable clinical manifestations and a similar endocarditis prevalence but higher mortality than industrialised countries. S. aureus bacteraemia is frequently associated with exposure to healthcare settings with MRSA causing a considerable burden of disease. Further studies are required to define setting-specific strategies to reduce mortality from S. aureus bacteraemia, prevent MRSA transmission, and to define the burden of S. aureus disease and emergence of drug resistance throughout the developing world.
背景
大多数关于侵袭性金黄色葡萄球菌感染的信息来自温带国家。在热带地区，侵袭性金黄色葡萄球菌感染的流行病学、治疗、耐药性及转归方面存在相当大的知识空白。
方法
在泰国东北部一家拥有1000张床位的区域医院，对金黄色葡萄球菌菌血症进行了为期1年的前瞻性观察研究。收集详细的临床数据，并在12周时确定最终转归，同时将其与感染菌株的抗菌药物敏感性谱进行关联分析。
主要发现
招募了98例金黄色葡萄球菌菌血症患者。临床表现范围与温带国家报道的相似。心内膜炎患病率为14%。疾病负担在年龄两端最高，而死亡率随年龄增加。全因死亡率为52%，由金黄色葡萄球菌导致的死亡率为44%。耐甲氧西林金黄色葡萄球菌（MRSA）导致28%的感染，所有这些感染均与医疗保健相关。MRSA和甲氧西林敏感金黄色葡萄球菌（MSSA）的死亡率分别为67%（18/27）和46%（33/71）（p = 0.11）。MRSA菌株具有多重耐药性。仅万古霉素或夫西地酸适合作为疑似MRSA感染的经验性治疗选择。
结论
金黄色葡萄球菌是泰国东北部的一种重要病原体，其临床表现相当，心内膜炎患病率相似，但死亡率高于工业化国家。金黄色葡萄球菌菌血症常与接触医疗保健环境相关，MRSA造成相当大的疾病负担。需要进一步研究来确定针对特定环境的策略，以降低金黄色葡萄球菌菌血症的死亡率、预防MRSA传播，并确定整个发展中世界金黄色葡萄球菌疾病的负担及耐药性的出现情况。
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