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所致社区获得性肺炎的比较。
Comparison of community-acquired pneumonia due to methicillin-resistant and methicillin-susceptible Staphylococcus aureus producing the Panton-Valentine leukocidin.
机构信息
Alfa Institute of Biomedical Sciences, Athens, Greece.
出版信息
Int J Tuberc Lung Dis. 2009 Dec;13(12):1476-85.
OBJECTIVE
To investigate the clinical features and prognosis of patients with methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) community-acquired pneumonia (CAP) producing the Panton-Valentine leukocidin (PVL).
METHODS
PubMed and Scopus were searched. Inclusion was stratified according to S. aureus susceptibility and clinical, microbiological and outcome data of patients with S. aureus CAP; both primary and secondary cases of CAP (hematogenous spread from other sites of infection) were included.
RESULTS
We identified 71 articles reporting data on patients with MRSA (n = 76) and MSSA (n = 31) PVL-positive CAP. There were no differences in demographics and history among patients with MRSA and MSSA CAP. Features associated with MRSA CAP were gastrointestinal tract symptoms (P = 0.016) and unilobar infiltrates (P = 0.043). Features associated with MSSA CAP were airway hemorrhage (P = 0.01), multilobar infiltrates (P = 0.043) and acute respiratory distress syndrome (ARDS, P = 0.023). Although MSSA patients were more likely to receive initial appropriate antimicrobial therapy (P < 0.001), there was no difference in mortality between the two groups (P = 0.919). Univariate analysis showed that influenza-like symptoms (P < 0.001), multi-organ failure (P < 0.001), admission to the intensive care unit (P < 0.001), mechanical ventilation (P < 0.001), leucopenia (P < 0.001), shock (P = 0.001), development of complications (P = 0.003), vein thrombosis (P < 0.001), disseminated intravascular coagulation (P = 0.03), acidosis (P = 0.012), rash (P = 0.024), ARDS (P = 0.021), necrotizing pneumonia (P = 0.026), and use of macrolides after culture results (P = 0.011) were factors associated with death.
CONCLUSIONS
Patients with MRSA PVL-positive CAP did not have higher rates of mortality than patients with MSSA PVL-positive CAP.
目的
研究产杀白细胞素金黄色葡萄球菌（PVL）的耐甲氧西林金黄色葡萄球菌（MRSA）和甲氧西林敏感金黄色葡萄球菌（MSSA）社区获得性肺炎（CAP）患者的临床特征和预后。
方法
在 PubMed 和 Scopus 上进行检索。根据金黄色葡萄球菌的敏感性和金黄色葡萄球菌 CAP 患者的临床、微生物学和结局数据进行分层纳入，包括原发性和继发性 CAP（血源播散自其他感染部位）。
结果
我们共确定了 71 篇报道了产 PVL 的 MRSA（n = 76）和 MSSA（n = 31）CAP 患者数据的文章。MRSA 和 MSSA CAP 患者的人口统计学和病史无差异。MRSA CAP 相关特征为胃肠道症状（P = 0.016）和单侧浸润（P = 0.043）。MSSA CAP 相关特征为气道出血（P = 0.01）、多肺叶浸润（P = 0.043）和急性呼吸窘迫综合征（ARDS，P = 0.023）。尽管 MSSA 患者更有可能接受初始适当的抗菌治疗（P < 0.001），但两组死亡率无差异（P = 0.919）。单因素分析显示流感样症状（P < 0.001）、多器官功能衰竭（P < 0.001）、入住重症监护病房（P < 0.001）、机械通气（P < 0.001）、白细胞减少（P < 0.001）、休克（P = 0.001）、并发症发生（P = 0.003）、静脉血栓形成（P < 0.001）、弥漫性血管内凝血（P = 0.03）、酸中毒（P = 0.012）、皮疹（P = 0.024）、ARDS（P = 0.021）、坏死性肺炎（P = 0.026）和培养结果后使用大环内酯类药物（P = 0.011）与死亡相关。
结论
产 PVL 的 MRSA CAP 患者的死亡率不比产 PVL 的 MSSA CAP 患者高。
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