Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherland.
Antimicrob Agents Chemother. 2011 Apr;55(4):1598-605. doi: 10.1128/AAC.01157-10. Epub 2011 Jan 10.
Antimicrobial resistance is threatening the successful management of nosocomial infections worldwide. Despite the therapeutic limitations imposed by methicillin-resistant Staphylococcus aureus (MRSA), its clinical impact is still debated. The objective of this study was to estimate the excess mortality and length of hospital stay (LOS) associated with MRSA bloodstream infections (BSI) in European hospitals. Between July 2007 and June 2008, a multicenter, prospective, parallel matched-cohort study was carried out in 13 tertiary care hospitals in as many European countries. Cohort I consisted of patients with MRSA BSI and cohort II of patients with methicillin-susceptible S. aureus (MSSA) BSI. The patients in both cohorts were matched for LOS prior to the onset of BSI with patients free of the respective BSI. Cohort I consisted of 248 MRSA patients and 453 controls and cohort II of 618 MSSA patients and 1,170 controls. Compared to the controls, MRSA patients had higher 30-day mortality (adjusted odds ratio [aOR] = 4.4) and higher hospital mortality (adjusted hazard ratio [aHR] = 3.5). Their excess LOS was 9.2 days. MSSA patients also had higher 30-day (aOR = 2.4) and hospital (aHR = 3.1) mortality and an excess LOS of 8.6 days. When the outcomes from the two cohorts were compared, an effect attributable to methicillin resistance was found for 30-day mortality (OR = 1.8; P = 0.04), but not for hospital mortality (HR = 1.1; P = 0.63) or LOS (difference = 0.6 days; P = 0.96). Irrespective of methicillin susceptibility, S. aureus BSI has a significant impact on morbidity and mortality. In addition, MRSA BSI leads to a fatal outcome more frequently than MSSA BSI. Infection control efforts in hospitals should aim to contain infections caused by both resistant and susceptible S. aureus.
抗微生物药物耐药性正在威胁着全球范围内医院获得性感染的成功管理。尽管耐甲氧西林金黄色葡萄球菌（MRSA）带来了治疗上的限制，但它的临床影响仍存在争议。本研究的目的是评估欧洲医院耐甲氧西林金黄色葡萄球菌血流感染（BSI）相关的超额死亡率和住院时间（LOS）。2007 年 7 月至 2008 年 6 月，在 13 个欧洲国家的 13 家三级护理医院进行了一项多中心、前瞻性、平行匹配队列研究。队列 I 由耐甲氧西林金黄色葡萄球菌 BSI 患者组成，队列 II 由甲氧西林敏感金黄色葡萄球菌（MSSA）BSI 患者组成。两组患者均按 BSI 发病前 LOS 与无相应 BSI 的患者相匹配。队列 I 包括 248 例耐甲氧西林金黄色葡萄球菌患者和 453 名对照者，队列 II 包括 618 例 MSSA 患者和 1170 名对照者。与对照组相比，耐甲氧西林金黄色葡萄球菌患者的 30 天死亡率更高（校正比值比[aOR] = 4.4），住院死亡率更高（校正风险比[aHR] = 3.5）。他们的超额 LOS 为 9.2 天。MSSA 患者的 30 天（aOR = 2.4）和住院（aHR = 3.1）死亡率更高，超额 LOS 为 8.6 天。当比较两个队列的结果时，发现耐甲氧西林耐药性与 30 天死亡率（OR = 1.8；P = 0.04）相关，但与住院死亡率（HR = 1.1；P = 0.63）或 LOS（差异= 0.6 天；P = 0.96）无关。金黄色葡萄球菌 BSI 无论耐甲氧西林敏感与否，都会对发病率和死亡率产生重大影响。此外，耐甲氧西林金黄色葡萄球菌 BSI 导致的致死后果比甲氧西林敏感金黄色葡萄球菌 BSI 更为常见。医院感染控制工作应旨在控制耐药和敏感金黄色葡萄球菌引起的感染。
