Bar-Meir Maskit, Tan Tina Q
Children's Memorial Hospital, Chicago, IL, USA.
Clin Pediatr (Phila). 2010 May;49(5):432-8. doi: 10.1177/0009922809350496. Epub 2010 Jan 28.
This prospective study was designed to evaluate predictors of skin and soft tissue infections (SSTI) due to community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA). Consecutive patients who were hospitalized with S aureus SSTI were enrolled. CA-MRSA infection was diagnosed in 76% of the children. MRSA SSTI was associated with black race (P = .0001) and with infection involving the lower trunk (P = .008). Only 21% of the patients in this study had S aureus colonization in their nares, and in 3 cases there was discordance between the nares and the infection site cultures. Sensitivity, specificity, and predictive values of the risk factors examined were limited in their ability to predict CA-MRSA infection. Given the high prevalence of MRSA in our community and the inability of nasal cultures to reliably predict CA-MRSA infection, empirical antibiotic therapy active against CA-MRSA and contact isolation of patients are recommended.
这项前瞻性研究旨在评估社区获得性耐甲氧西林金黄色葡萄球菌（CA-MRSA）所致皮肤和软组织感染（SSTI）的预测因素。纳入因金黄色葡萄球菌SSTI住院的连续患者。76%的儿童被诊断为CA-MRSA感染。MRSA SSTI与黑人种族相关（P = 0.0001），且与下躯干感染相关（P = 0.008）。本研究中仅21%的患者鼻腔有金黄色葡萄球菌定植，3例患者鼻腔与感染部位培养结果不一致。所检查的危险因素的敏感性、特异性和预测价值在预测CA-MRSA感染方面能力有限。鉴于我们社区中MRSA的高流行率以及鼻腔培养无法可靠预测CA-MRSA感染，建议采用针对CA-MRSA的经验性抗生素治疗并对患者进行接触隔离。
