Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan, Republic of China.
Eur J Clin Microbiol Infect Dis. 2010 Dec;29(12):1539-46. doi: 10.1007/s10096-010-1038-4. Epub 2010 Sep 18.
This observational study enrolled adult patients with bacteremia due to methicillin-resistant Staphylococcus aureus (MRSA) who were treated at the emergency department of a teaching hospital from 2001 to 2007. MRSA isolates with type IV and type V staphylococcal cassette chromosome mec (SCCmec) genes (SCC IV/V-MRSA) were included in the final analysis. Healthcare-associated SCC IV/V-MRSA (HA-SCC IV/V-MRSA) and community-acquired SCC IV/V-MRSA (CA-SCC IV/V-MRSA) were defined as the identification of an SCC IV/V-MRSA isolate from a patient with and without healthcare-associated risk factors, respectively. Thirty-four cases of CA-SCC IV/V-MRSA (20 SCCmec type IV, 14 SCCmec type V) and 81 cases of HA-SCC IV/V-MRSA (59 SCCmec type IV, 22 SCCmec type V) bacteremia were identified. Vascular device-associated infections were a significant infection source in HA-SCC IV/V-MRSA bacteremia cases. SCCmec type IV HA-SCC IV/V-MRSA isolates (3.4%) were significantly less likely to carry the Panton-Valentine leukocidin (PVL) gene than SCCmec type IV CA-SCC IV/V-MRSA isolates (35.0%, p = 0.001). The 90-day cumulative probability of survival was 76% for patients with CA-SCC IV/V-MRSA bacteremia and 66% for patients with HA-SCC IV/V-MRSA bacteremia (p = 0.247, by the Wilcoxon rank-sum test). Significant differences in antimicrobial susceptibility were observed between bacterial isolates from patients with CA-SCC IV/V-MRSA bacteremia and HA-SCC IV/V-MRSA bacteremia.
这项观察性研究纳入了 2001 年至 2007 年在一家教学医院急诊科治疗的耐甲氧西林金黄色葡萄球菌（MRSA）菌血症成年患者。最终分析纳入了携带 IV 型和 V 型葡萄球菌盒式染色体 mec（SCCmec）基因（SCC IV/V-MRSA）的 MRSA 分离株。将与医疗保健相关的 SCC IV/V-MRSA（HA-SCC IV/V-MRSA）和社区获得性 SCC IV/V-MRSA（CA-SCC IV/V-MRSA）定义为从无医疗保健相关危险因素和有医疗保健相关危险因素的患者中鉴定出 SCC IV/V-MRSA 分离株。鉴定出 34 例 CA-SCC IV/V-MRSA（20 型 SCCmec 型 IV，14 型 SCCmec 型 V）和 81 例 HA-SCC IV/V-MRSA（59 型 SCCmec 型 IV，22 型 SCCmec 型 V）菌血症。血管内装置相关感染是 HA-SCC IV/V-MRSA 菌血症病例的重要感染源。与 SCCmec 型 IV CA-SCC IV/V-MRSA 分离株（35.0%）相比，SCCmec 型 IV HA-SCC IV/V-MRSA 分离株（3.4%）携带杀白细胞素基因（PVL）的可能性显著降低（p=0.001）。CA-SCC IV/V-MRSA 菌血症患者 90 天累积生存率为 76%，HA-SCC IV/V-MRSA 菌血症患者为 66%（Wilcoxon 秩和检验，p=0.247）。CA-SCC IV/V-MRSA 菌血症和 HA-SCC IV/V-MRSA 菌血症患者分离株的抗菌药物敏感性存在显著差异。
