耐甲氧西林金黄色葡萄球菌医院获得性肺炎的致病性预测因素。

Predictors of the pathogenicity of methicillin-resistant Staphylococcus aureus nosocomial pneumonia.

机构信息

Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; Second Department of Internal Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; First Department of Internal Medicine, Hokkaido University Hospital, Hokkaido, Japan.

出版信息

Respirology. 2014 May;19(4):556-62. doi: 10.1111/resp.12288. Epub 2014 Apr 8.

DOI:10.1111/resp.12288

PMID:24735338

Abstract

BACKGROUND AND OBJECTIVE

The clinical characteristics of patients with nosocomial pneumonia (NP) associated with methicillin-resistant Staphylococcus aureus (MRSA) infection are not well characterized.

METHODS

Three hundred and thirty-seven consecutive patients with MRSA isolation from respiratory specimens who attended our hospital between April 2007 and March 2011 were enrolled. Patients characteristics diagnosed with 'true' MRSA-NP were described with regards to clinical, microbiological features, radiological features and genetic characteristics of the isolates. The diagnosis of 'true' MRSA-NP was confirmed by anti-MRSA treatment effects, Gram-staining or bronchoalveolar lavage fluid culture.

RESULTS

Thirty-six patients were diagnosed with 'true' MRSA-NP, whereas 34 were diagnosed with NP with MRSA colonization. Patients with a MRSA-NP had a Pneumonia Patient Outcomes Research Team score of 5 (58.3% vs 23.5%), single cultivation of MRSA (83.3% vs 38.2%), MRSA quantitative cultivation yielding more than 10(6) CFU/mL (80.6% vs 47.1%), radiological findings other than lobar pneumonia (66.7% vs 26.5%), and a history of head, neck, oesophageal or stomach surgery (30.6% vs 11.8%). These factors were shown to be independent predictors of the pathogenicity of 'true' MRSA-NP by multivariate analysis (P < 0.05).

CONCLUSIONS

'True' MRSA-NP shows distinct clinical and radiological features from NP with MRSA colonization.

摘要

背景与目的

耐甲氧西林金黄色葡萄球菌（MRSA）引起的医院获得性肺炎（NP）的临床特征尚未完全明确。

方法

选择 2007 年 4 月至 2011 年 3 月我院收治的 337 例连续 MRSA 呼吸道标本分离患者，描述临床、微生物学、影像学和分离株遗传特征等方面确诊为“真正”MRSA-NP 的患者特征。“真正”MRSA-NP 诊断通过抗-MRSA 治疗效果、革兰染色或支气管肺泡灌洗液培养确定。

结果

36 例患者被诊断为“真正”MRSA-NP，34 例患者被诊断为 NP 合并 MRSA 定植。MRSA-NP 患者肺炎患者结局研究组评分 5 分（58.3%比 23.5%）、单一 MRSA 培养（83.3%比 38.2%）、MRSA 定量培养大于 10(6)CFU/mL（80.6%比 47.1%）、非大叶性肺炎影像学表现（66.7%比 26.5%）、头颈部、食管或胃手术史（30.6%比 11.8%）。多因素分析显示，这些因素是“真正”MRSA-NP 致病性的独立预测因子（P < 0.05）。