BMC Infect Dis. 2013 May 30;13:252. doi: 10.1186/1471-2334-13-252.
Skin and soft tissue infections (SSTIs) are commonly occurring infections with wide-ranging clinical manifestations, from mild to life-threatening. There are few population-based studies of SSTIs in the period after the rapid increase in community-acquired methicillin-resistant Staphyloccus aureus (MRSA).
We used electronic databases to describe the incidence, microbiology, and patient characteristics of clinically-diagnosed skin and soft tissue infections (SSTIs) among members of a Northern California integrated health plan. We identified demographic risk factors associated with SSTIs and MRSA infection.
During the three-year study period from 2009 to 2011, 376,262 individuals experienced 471,550 SSTI episodes, of which 23% were cultured. Among cultured episodes, 54% were pathogen-positive. Staphylococcus aureus (S. aureus) was isolated in 81% of pathogen-positive specimens, of which nearly half (46%) were MRSA. The rate of clinically-diagnosed SSTIs in this population was 496 per 10,000 person-years. After adjusting for age group, gender, race/ethnicity and diabetes, Asians and Hispanics were at reduced risk of SSTIs compared to whites, while diabetics were at substantially higher risk compared to non-diabetics. There were strong age group by race/ethnicity interactions, with African Americans aged 18 to <50 years being disproportionately at risk for SSTIs compared to persons in that age group belonging to other race/ethnicity groups. Compared to Whites, S. aureus isolates of African-Americans and Hispanics were more likely to be MRSA (Odds Ratio (OR): 1.79, Confidence Interval (CI): 1.67 to 1.92, and, OR: 1.24, CI: 1.18 to 1.31, respectively), while isolates from Asians were less likely to be MRSA (OR: 0.73, CI: 0.68 to 0.78).
SSTIs represent a significant burden to the health care system. The majority of culture-positive SSTIs were caused by S. aureus, and almost half of the S. aureus SSTIs were methicillin-resistant. The reasons for African-Americans having a higher likelihood, and Asians a lower likelihood, for their S. aureus isolates to be methicillin-resistant, should be further investigated.
皮肤和软组织感染（SSTIs）是一种常见的感染，临床表现广泛，从轻症到危及生命不等。在社区获得性耐甲氧西林金黄色葡萄球菌（MRSA）迅速增加之后，有关 SSTIs 的人群研究较少。
我们使用电子数据库描述了加利福尼亚北部一家综合医疗计划成员中临床诊断的皮肤和软组织感染（SSTIs）的发病率、微生物学和患者特征。我们确定了与 SSTIs 和 MRSA 感染相关的人口统计学风险因素。
在 2009 年至 2011 年的三年研究期间，376262 人经历了 471550 例 SSTI 发作，其中 23%进行了培养。在培养的发作中，54%为病原体阳性。金黄色葡萄球菌（S. aureus）在 81%的病原体阳性标本中分离出来，其中近一半（46%）为 MRSA。该人群中临床诊断的 SSTIs 发生率为每 10000 人年 496 例。在调整年龄组、性别、种族/族裔和糖尿病后，与白人相比，亚洲人和西班牙裔人群患 SSTIs 的风险较低，而与非糖尿病患者相比，糖尿病患者的风险明显更高。年龄组与种族/族裔之间存在强烈的相互作用，18 至<50 岁的非裔美国人与属于其他种族/族裔的同年龄组人群相比，患 SSTIs 的风险更高。与白人相比，非裔美国人和西班牙裔人的金黄色葡萄球菌分离株更有可能是耐甲氧西林金黄色葡萄球菌（优势比（OR）：1.79，置信区间（CI）：1.67 至 1.92，和，OR：1.24，CI：1.18 至 1.31），而亚洲人的金黄色葡萄球菌分离株不太可能是耐甲氧西林金黄色葡萄球菌（OR：0.73，CI：0.68 至 0.78）。
SSTIs 对医疗保健系统构成了重大负担。大多数培养阳性的 SSTIs 是由金黄色葡萄球菌引起的，几乎一半的金黄色葡萄球菌 SSTIs 是耐甲氧西林的。非裔美国人金黄色葡萄球菌分离株更有可能，亚洲人的金黄色葡萄球菌分离株更不可能是耐甲氧西林金黄色葡萄球菌的原因，应进一步调查。
