Unité de Pharmaco-Épidémiologie et Maladies Infectieuses, Institut Pasteur, Paris U657, Institut National de la Santé et de la Recherche Médicale, Paris EA 4499, Université de Versailles-Saint-Quentin-en-Yvelines, Montigny le Bretonneux.
Service de Microbiologie, Hôpital Raymond Poincaré, Garches.
Clin Infect Dis. 2014 Jul 15;59(2):206-15. doi: 10.1093/cid/ciu236. Epub 2014 Apr 11.
Methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization is a well-established risk factor for subsequent infection and a key event in interindividual transmission. Some studies have showed an association between fluoroquinolones and MRSA colonization or infection. The present study was performed to identify specific risk factors for MRSA acquisition in long-term care facilities (LTCFs).
A prospective cohort of patients naive for S. aureus colonization was established and followed (January 2008 through October 2010) in 4 French LTCFs. Nasal colonization status and potential risk factors were assessed weekly for 13 weeks after inclusion. Variables associated with S. aureus acquisition were identified in a nested-matched case-case-control study using conditional logistic regression models. Cases were patients who acquired MRSA (or methicillin-sensitive S. aureus [MSSA]). Patients whose nasal swab samples were always negative served as controls. Matching criteria were center, date of first nasal swab sample, and exposure time.
Among 451 included patients, 76 MRSA cases were matched to 207 controls and 112 MSSA cases to 208 controls. Multivariable analysis retained fluoroquinolones (odds ratio, 2.17; 95% confidence interval, 1.01-4.67), male sex (2.09; 1.10-3.98), and more intensive care at admission (3.24; 1.74-6.04) as significantly associated with MRSA acquisition, and body-washing assistance (2.85; 1.27-6.42) and use of a urination device (1.79; 1.01-3.18) as significantly associated with MSSA acquisition.
Our results suggest that fluoroquinolones are a risk factor for MRSA acquisition. Control measures to limit MRSA spread in LTCFs should also be based on optimization of fluoroquinolone use.
耐甲氧西林金黄色葡萄球菌（MRSA）鼻腔定植是随后感染的既定危险因素，也是个体间传播的关键事件。一些研究表明氟喹诺酮类药物与 MRSA 定植或感染之间存在关联。本研究旨在确定长期护理机构（LTCF）中获得 MRSA 的特定危险因素。
建立了一个对金黄色葡萄球菌定植呈初始状态的前瞻性队列，并对其进行了随访（2008 年 1 月至 2010 年 10 月），该队列包括 4 家法国 LTCF 的患者。纳入后 13 周内每周评估鼻腔定植状态和潜在危险因素。使用条件逻辑回归模型，在嵌套匹配病例对照研究中确定与金黄色葡萄球菌获得相关的变量。病例为获得 MRSA（或甲氧西林敏感金黄色葡萄球菌 [MSSA]）的患者。鼻腔拭子样本始终为阴性的患者作为对照。匹配标准为中心、首次鼻腔拭子样本日期和暴露时间。
在 451 名纳入的患者中，76 例 MRSA 病例与 207 例对照、112 例 MSSA 病例与 208 例对照相匹配。多变量分析保留了氟喹诺酮类药物（比值比，2.17；95%置信区间，1.01-4.67）、男性（2.09；1.10-3.98）和入院时更密集的护理（3.24；1.74-6.04）与 MRSA 获得显著相关，而身体洗涤辅助（2.85；1.27-6.42）和使用排尿装置（1.79；1.01-3.18）与 MSSA 获得显著相关。
我们的结果表明氟喹诺酮类药物是 MRSA 获得的危险因素。为了在 LTCF 中限制 MRSA 的传播，控制措施还应基于优化氟喹诺酮类药物的使用。
