Department of Microbiology, Sunnybrook Health Sciences Centre, Hospital for Sick Children, Toronto, Ontario, Canada.
Infect Control Hosp Epidemiol. 2010 Apr;31(4):348-56. doi: 10.1086/651313.
To determine the incidence and describe the changing epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) colonization or infection in Canadian hospitals from 1995-2007.
Forty-eight hospitals participating in the Canadian Nosocomial Infection Surveillance Program.
Prospective, laboratory-based surveillance for incident cases of MRSA colonization or infection among hospitalized patients.
Clinical and epidemiologic data were obtained by review of hospital records. Standard criteria were used to determine whether MRSA colonization or infection was present and whether the MRSA strain was healthcare associated or community associated. A representative subset of isolates was characterized by use of pulsed-field gel electrophoresis and staphylococcal cassette chromosome (SCC) mec typing.
From 1995 to 2007, a total of 37,169 hospitalized patients were newly identified as either infected or colonized with MRSA, and the overall incidence of both MRSA colonization and MRSA infection increased from 0.65 to 11.04 cases per 10,000 patient-days (P < .001). Of these 37,169 patients, 11,828 (32%) had an MRSA infection, and infection rate increased from 0.36 to 3.43 cases per 10,000 patient-days. The proportion of community-associated MRSA strains increased from 6% to 23% (P < .001). The most common genotype (47% of isolates) was CMRSA-2 (USA100/800); in 2007, CMRSA-10 (USA300) was the second most common strain (27% of isolates), associated with SCCmec type IV. Patients with CMRSA-10 were predominantly from western Canada and were more likely to be children (odds ratio [OR], 10.0 [95% confidence interval {CI}, 7.4-13.4]) and to have infection (OR, 2.3 [95% CI, 1.9-2.7]), especially skin and/or soft tissue infection (OR, 5.9 [95% CI, 5.0-6.9]).
The overall incidence of both MRSA colonization and MRSA infection increased 17-fold in Canadian hospitals from 1995 to 2007. There has also been a dramatic increase in cases of community-associated MRSA infection due to the CMRSA-10 (USA300) clone. Continued surveillance is needed to monitor the ongoing evolution of MRSA colonization or infection in Canada and globally.
确定从 1995 年至 2007 年加拿大医院中耐甲氧西林金黄色葡萄球菌（MRSA）定植或感染的发生率，并描述其流行情况的变化。
48 家参与加拿大医院感染监测计划的医院。
对住院患者中发生的 MRSA 定植或感染的新发病例进行前瞻性、基于实验室的监测。
通过审查医院记录获得临床和流行病学数据。使用标准标准来确定是否存在 MRSA 定植或感染，以及 MRSA 菌株是否与医疗保健相关或与社区相关。使用脉冲场凝胶电泳和葡萄球菌盒式染色体（SCC）mec 型对代表性分离株亚群进行特征描述。
从 1995 年至 2007 年，共有 37169 名住院患者被新诊断为 MRSA 定植或感染，MRSA 定植和感染的总发生率从 0.65 增加至 11.04 例/10000 患者-天（P < 0.001）。在这 37169 名患者中，有 11828 名（32%）患有 MRSA 感染，感染率从 0.36 增加至 3.43 例/10000 患者-天。社区相关 MRSA 菌株的比例从 6%增加至 23%（P < 0.001）。最常见的基因型（47%的分离株）为 CMRSA-2（USA100/800）；2007 年，CMRSA-10（USA300）是第二常见的菌株（27%的分离株），与 SCCmec 型 IV 相关。CMRSA-10 患者主要来自加拿大西部，更可能是儿童（优势比[OR]，10.0 [95%置信区间{CI}，7.4-13.4]），并且更有可能发生感染（OR，2.3 [95%CI，1.9-2.7]），尤其是皮肤和/或软组织感染（OR，5.9 [95%CI，5.0-6.9]）。
从 1995 年至 2007 年，加拿大医院中 MRSA 定植和感染的总发生率增加了 17 倍。由于 CMRSA-10（USA300）克隆的存在，社区相关的 MRSA 感染病例也急剧增加。需要继续监测，以监测加拿大和全球范围内 MRSA 定植或感染的持续演变。
