López Furst María José, de Vedia Lautaro, Fernández Silvina, Gardella Noella, Ganaha María Cristina, Prieto Sergio, Carbone Edith, Lista Nicolás, Rotryng Flavio, Morera Graciana I, Mollerach Marta, Stryjewski Martín E
Unidad de Infectología, Sanatorio Municipal Dr. Julio Méndez, Ciudad Autónoma de Buenos Aires, Argentina.
PLoS One. 2013 Nov 20;8(11):e78303. doi: 10.1371/journal.pone.0078303. eCollection 2013.
Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is now the most common cause of skin and skin structure infections (SSSI) in several world regions. In Argentina prospective, multicenter clinical studies have only been conducted in pediatric populations.
PRIMARY: describe the prevalence, clinical and demographic characteristics of adult patients with community acquired SSSI due to MRSA; secondary: molecular evaluation of CA-MRSA strains. Patients with MRSA were compared to those without MRSA.
Prospective, observational, multicenter, epidemiologic study, with molecular analysis, conducted at 19 sites in Argentina (18 in Buenos Aires) between March 2010 and October 2011. Patients were included if they were ≥ 14 years, were diagnosed with SSSI, a culture was obtained, and there had no significant healthcare contact identified. A logistic regression model was used to identify factors associated with CA-MRSA. Pulse field types, SCCmec, and PVL status were also determined.
A total of 311 patients were included. CA-MRSA was isolated in 70% (218/311) of patients. Clinical variables independently associated with CA-MRSA were: presence of purulent lesion (OR 3.29; 95%CI 1.67, 6.49) and age <50 years (OR 2.39; 95%CI 1.22, 4.70). The vast majority of CA-MRSA strains causing SSSI carried PVL genes (95%) and were SCCmec type IV. The sequence type CA-MRSA ST30 spa t019 was the predominant clone.
CA-MRSA is now the most common cause of SSSI in our adult patients without healthcare contact. ST30, SCCmec IV, PVL+, spa t019 is the predominant clone in Buenos Aires, Argentina.
社区获得性耐甲氧西林金黄色葡萄球菌（CA-MRSA）现已成为世界上多个地区皮肤及皮肤结构感染（SSSI）的最常见病因。在阿根廷，仅针对儿科人群开展了前瞻性、多中心临床研究。
主要目的：描述因MRSA导致社区获得性SSSI的成年患者的患病率、临床及人口统计学特征；次要目的：对CA-MRSA菌株进行分子评估。将MRSA患者与非MRSA患者进行比较。
2010年3月至2011年10月在阿根廷的19个地点（布宜诺斯艾利斯18个）开展了一项带有分子分析的前瞻性、观察性、多中心流行病学研究。纳入标准为年龄≥14岁、被诊断为SSSI、已获取培养物且未发现有显著的医疗接触史。采用逻辑回归模型来确定与CA-MRSA相关的因素。同时还确定了脉冲场类型、SCCmec及杀白细胞素（PVL）状态。
共纳入311例患者。70%（218/311）的患者分离出CA-MRSA。与CA-MRSA独立相关的临床变量为：存在脓性病变（比值比[OR]3.29；95%置信区间[CI]1.67, 6.49）及年龄<50岁（OR 2.39；95%CI 1.22, 4.70）。绝大多数导致SSSI的CA-MRSA菌株携带PVL基因（95%）且为SCCmec IV型。CA-MRSA序列类型ST30 spa t019是主要克隆型。
CA-MRSA现已成为我们未接触医疗保健的成年患者中SSSI的最常见病因。ST30、SCCmec IV、PVL+、spa t019是阿根廷布宜诺斯艾利斯的主要克隆型。
