退伍军人金黄色葡萄球菌感染中与耐甲氧西林相关的危险因素。

Risk factors associated with methicillin resistance among Staphylococcus aureus infections in veterans.

机构信息

Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.

出版信息

Infect Control Hosp Epidemiol. 2010 Jan;31(1):36-41. doi: 10.1086/649017.

DOI:10.1086/649017

PMID:19929688

Abstract

BACKGROUND

Methicillin-resistant Staphylococcus aureus (MRSA) is an emerging concern in infectious disease practice. Although MRSA infections occur in a wide variety of anatomic sites, the majority of studies considering the risk factors for methicillin resistance among S. aureus infections have focused on MRSA bacteremia.

OBJECTIVE

To describe risk factors associated with methicillin resistance among S. aureus infections at different anatomic sites.

METHODS

We collected information on the demographic and clinical characteristics of patients examined at the Atlanta Veterans Affairs Medical Center with S. aureus infections during the period from June 2007 through May 2008. We used multivariate logistic regression to describe factors significantly associated with methicillin resistance.

RESULTS

There were 568 cases of S. aureus infection among 528 patients. We identified 352 cases (62%) of MRSA infection and 216 cases (38%) of methicillin-sensitive S. aureus infection. The adjusted odds of methicillin resistance were higher among infections that occurred among patients who had a prior history of MRSA infection (odds ratio [OR], 3.9 [95% confidence interval {CI}, 2.3-6.4]) or resided in a long-term care facility during the past 12 months (OR, 2.0 [95% CI, 1.0-4.0]) but were lower for infections that occurred among patients who had undergone a biopsy procedure during the past 12 months (OR, 0.7 [95% CI, 0.6-0.9]). Most cases of infection were community-onset infections (523 [92%] of 568 cases), and about one-half (278 [49%]) were not healthcare associated.

CONCLUSIONS

Compared with previous studies of methicillin resistance among patients with S. aureus bacteremia, we found similar factors to be associated with methicillin resistance among S. aureus isolates recovered from more diverse anatomic sites of infection. Of note, nearly one-half of our cases of MRSA infection were not healthcare associated.

摘要

背景

耐甲氧西林金黄色葡萄球菌（MRSA）是传染病实践中一个新出现的问题。尽管 MRSA 感染发生在广泛的解剖部位，但大多数研究 MRSA 感染中耐甲氧西林的危险因素的研究都集中在 MRSA 菌血症上。

目的

描述不同解剖部位金黄色葡萄球菌感染中与耐甲氧西林相关的危险因素。

方法

我们收集了 2007 年 6 月至 2008 年 5 月期间在亚特兰大退伍军人事务医疗中心接受金黄色葡萄球菌感染检查的患者的人口统计学和临床特征信息。我们使用多变量逻辑回归来描述与耐甲氧西林显著相关的因素。

结果

在 528 名患者中，有 568 例金黄色葡萄球菌感染。我们确定了 352 例（62%）MRSA 感染和 216 例（38%）甲氧西林敏感金黄色葡萄球菌感染。在过去 12 个月中有 MRSA 感染史（比值比 [OR]，3.9 [95%置信区间 {CI}，2.3-6.4]）或居住在长期护理机构（OR，2.0 [95% CI，1.0-4.0]）的患者感染中，耐甲氧西林的调整后几率更高，但在过去 12 个月中进行过活检的患者感染中几率较低（OR，0.7 [95% CI，0.6-0.9]）。大多数感染是社区发病的感染（568 例中的 523 例[92%]），约一半（278 例[49%]）与医疗保健无关。