Division of Infectious Diseases and Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90502, USA.
Clin Microbiol Infect. 2010 May;16(5):425-31. doi: 10.1111/j.1469-0691.2009.02836.x. Epub 2009 Aug 18.
Efforts to control spread of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) are often based on eradication of colonization. However, the role of nasal and non-nasal colonization in the pathogenesis of these infections remains poorly understood. Patients with acute S. aureus skin and soft tissue infection (SSTI) were prospectively enrolled. Each subject's nasal, axillary, inguinal and rectal areas were swabbed for S. aureus and epidemiological risk factors were surveyed. Among the 117 patients enrolled, there were 99 patients who had an SSTI and for whom data could be analysed. Sixty-five patients had a CA-MRSA SSTI. Among these patients, MRSA colonization in the nares, axilla, inguinal area and rectum was 25, 6, 11 and 13%, respectively, and 37% overall were MRSA colonized. Most (96%) MRSA colonization was detected using nose and inguinal screening alone. Non-nasal colonization was 25% among CA-MRSA patients, but only 6% among patients with CA-methicillin-susceptible S. aureus (MSSA) or healthcare-associated MRSA or MSSA. These findings suggest that colonization patterns in CA-MRSA infection are distinct from those in non-CA-MRSA S. aureus infections. The relatively high prevalence of non-nasal colonization may play a key role in CA-MRSA transmission and acquisition of infection.
努力控制社区相关性耐甲氧西林金黄色葡萄球菌（CA-MRSA）的传播通常基于消除定植。然而，鼻腔和非鼻腔定植在这些感染的发病机制中的作用仍知之甚少。前瞻性纳入患有急性金黄色葡萄球菌皮肤和软组织感染（SSTI）的患者。对每个患者的鼻腔、腋窝、腹股沟和直肠区域进行金黄色葡萄球菌拭子采样，并调查流行病学危险因素。在纳入的 117 名患者中，有 99 名患者患有 SSTI，可对其数据进行分析。65 名患者患有 CA-MRSA SSTI。在这些患者中，MRSA 在鼻腔、腋窝、腹股沟和直肠的定植率分别为 25%、6%、11%和 13%，总体定植率为 37%。大多数（96%）MRSA 定植仅通过鼻和腹股沟筛查即可检测到。CA-MRSA 患者中非鼻腔定植率为 25%，但 CA-甲氧西林敏感金黄色葡萄球菌（MSSA）或医源性 MRSA 或 MSSA 患者中仅为 6%。这些发现表明，CA-MRSA 感染中的定植模式与非 CA-MRSA 金黄色葡萄球菌感染中的定植模式不同。非鼻腔定植的相对较高的流行率可能在 CA-MRSA 传播和感染获得中起关键作用。
