Li Fenfang, Arnsberger Pamela, Miller F DeWolfe
Myron B. Thompson School of Social Work, University of Hawai'i, Honolulu, HI 96822, USA.
Hawaii Med J. 2010 May;69(5):126-9.
Residing in long-term care facilities has long been identified as a risk factor for methicillin-resistant Staphylococcus aureus (MRSA) carriage and infection. The objective of this study was to describe MRSA epidemiology among residents in skilled nursing and intermediate care facilities (SNF/ICF) in Hawai'i, using a statewide, population-based antimicrobial resistance surveillance system. From 2000 to 2005, proportions of MRSA increased significantly during the 6-year study period, from 35.0% in 2000 to 58.6% in 2005 (p < 0.001). High levels of MRSA resistance to several commonly used antibiotics were observed, e.g., the level of MRSA resistance to clindamycin, ciprofloxacin, and erythromycin was at 77%, 90%, and 89% respectively. Nevertheless, there is a significant difference in the MRSA resistance pattern against certain antimicrobials in different geographic areas. For example, the level of MRSA resistance to trimethoprim-sulfamethoxazole was close to zero in Hawai'i County, but 13% in Kaua'i County. In contrast, the MRSA resistance to tetracycline was 46% in Hawai'i County, but 5% in Kaua'i County. Multi-drug resistant MRSA was well-established among nursing homes in Hawai'i. Regional antibiograms are important in the assistance of empirical therapy.
长期以来，居住在长期护理机构一直被视为耐甲氧西林金黄色葡萄球菌（MRSA）携带和感染的一个风险因素。本研究的目的是利用一个基于全州人口的抗菌药物耐药性监测系统，描述夏威夷州专业护理和中级护理机构（SNF/ICF）居民中的MRSA流行病学情况。在2000年至2005年的6年研究期间，MRSA的比例显著增加，从2000年的35.0%增至2005年的58.6%（p<0.001）。观察到MRSA对几种常用抗生素具有高水平耐药性，例如，MRSA对克林霉素、环丙沙星和红霉素的耐药水平分别为77%、90%和89%。然而，不同地理区域的MRSA对某些抗菌药物的耐药模式存在显著差异。例如，MRSA对甲氧苄啶-磺胺甲恶唑的耐药水平在夏威夷县接近零，但在考艾县为13%。相比之下，MRSA对四环素的耐药率在夏威夷县为46%，但在考艾县为5%。多重耐药MRSA在夏威夷的疗养院中已广泛存在。区域抗菌谱对经验性治疗的指导很重要。
