Ludwig-Maximilians-Universität, Division of Infectious Diseases, Medizinische Poliklinik - Campus Innenstadt, Klinikum der Universität, Munich, Germany.
J Hosp Infect. 2011 Dec;79(4):297-301. doi: 10.1016/j.jhin.2011.08.017. Epub 2011 Oct 21.
Staphylococcus aureus carriage increases the risk of infection. Demographic and microbiological data from adult patients with nasal S. aureus carriage were analysed in order to define effect modifiers of this association. Predictors for growth of S. aureus from clinical cultures were identified in a case-control study using bivariate and multi-variate logistic regression analysis. Between 1 January 2005 and 1 April 2009, 645 patients with nasal S. aureus colonization and documented follow-up of ≥90 days were identified; 159 (25%) patients were found to carry meticillin-resistant S. aureus (MRSA). The median age of patients was 58 years, and 421 (65%) were male. During the subsequent 90 days, one or more clinical cultures were positive for S. aureus in 131 patients (20%). Multi-variate analysis identified a prior history of any S. aureus positive culture [adjusted odds ratio (aOR) 2.4, 95% confidence interval (CI) 1.5-3.8; P=0.0005) as an independent predictor of subsequent S. aureus infection. MRSA colonization was a predictor of infection in patients aged >40 years (aOR 2.5, 95% CI 1.4-4.1; P=0.0004), and even more so in patients aged ≤40 years (aOR 12.4, 95% CI 3.0-51; P=0.0005). Age >40 years was an additional independent risk factor for meticillin-susceptible S. aureus carriers (aOR 3.0, 95% CI 1.2-7.8; P=0.02) but not for MRSA carriers. Preferential screening of patients at high risk for MRSA carriage and subsequent infection, as well as the absence of a universal policy for the use of decolonization regimens, may partly explain the relatively high risk of S. aureus infection in the patient population. MRSA carriers and older patients with recurrent S. aureus positive cultures may gain the greatest benefit from routine decolonization measures.
金黄色葡萄球菌定植增加了感染的风险。为了确定这种关联的影响因素，对成年金黄色葡萄球菌定植患者的人口统计学和微生物学数据进行了分析。采用二变量和多变量逻辑回归分析，在病例对照研究中确定了金黄色葡萄球菌临床培养物生长的预测因子。在 2005 年 1 月 1 日至 2009 年 4 月 1 日期间，共发现 645 例有鼻腔金黄色葡萄球菌定植并随访≥90 天的患者，其中 159 例（25%）为耐甲氧西林金黄色葡萄球菌（MRSA）。患者的中位年龄为 58 岁，421 例（65%）为男性。在随后的 90 天内，131 例（20%）患者的一个或多个临床培养物为金黄色葡萄球菌阳性。多变量分析显示，既往任何金黄色葡萄球菌阳性培养史[调整后的优势比（aOR）为 2.4，95%置信区间（CI）为 1.5-3.8；P=0.0005]是金黄色葡萄球菌感染的独立预测因子。MRSA 定植是>40 岁患者感染的预测因子（aOR 为 2.5，95%CI 为 1.4-4.1；P=0.0004），而对于≤40 岁患者则更是如此（aOR 为 12.4，95%CI 为 3.0-51；P=0.0005）。>40 岁是耐甲氧西林金黄色葡萄球菌携带者（aOR 为 3.0，95%CI 为 1.2-7.8；P=0.02）但不是 MRSA 携带者的另一个独立风险因素。高危 MRSA 定植和感染患者的选择性筛查，以及缺乏普遍的去定植方案政策，可能部分解释了金黄色葡萄球菌感染患者群体的相对高风险。MRSA 携带者和反复金黄色葡萄球菌阳性培养的老年患者可能从常规去定植措施中获益最大。
