2000-2009 年新生儿重症监护病房金黄色葡萄球菌血流感染的趋势。
Trends of Staphylococcus aureus bloodstream infections in a neonatal intensive care unit from 2000-2009.
机构信息
Department of Pediatrics, Division of Neonatology, University of Tennessee Health Science Center, Suite 201, 853 Jefferson Avenue, Memphis, TN 38163-0001, USA.
出版信息
BMC Pediatr. 2014 May 9;14:121. doi: 10.1186/1471-2431-14-121.
BACKGROUND
Invasive methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA) infections are major causes of numerous neonatal intensive care unit (NICU) outbreaks. There have been increasing reports of MRSA outbreaks in various neonatal intensive care units (NICUs) over the last decade. Our objective was to review the experience of Staphylococcus aureus sepsis in our NICU in the last decade and describe the trends in the incidence of Staphylococcus aureus blood stream infections from 2000 to 2009.
METHODS
A retrospective perinatal database review of all neonates admitted to our NICU with blood cultures positive for Staphylococcus aureus from (Jan 1st 2000 to December 31st 2009) was conducted. Infants were identified from the database and data were collected regarding their clinical characteristics and co-morbidities, including shock with sepsis and mortality. Period A represents patients admitted in 2000-2003. Period B represents patients seen in 2004-2009.
RESULTS
During the study period, 156/11111 infants were identified with Staphylococcus aureus blood stream infection: 41/4486 (0.91%) infants in Period A and 115/6625 (1.73%) in Period B (p < 0.0004). Mean gestation at birth was 26 weeks for infants in both periods. There were more MRSA infections in Period B (24% vs. 55% p < 0.05) and they were associated with more severe outcomes. In comparing the cases of MRSA infections observed in the two periods, infants in period B notably had significantly more pneumonia cases (2.4% vs. 27%, p = 0.0005) and a significantly higher mortality rate (0% vs. 15.7%, p = 0.0038). The incidences of skin and soft tissue infections and of necrotizing enterocolitis were not significantly changed in the two periods.
CONCLUSION
There was an increase in the incidence of Staphylococcus aureus infection among neonates after 2004. Although MSSA continues to be a problem in the NICU, MRSA infections were more prevalent in the past 6 years in our NICU. Increased severity of staphylococcal infections and associated rising mortality are possibly related to the increasing MRSA infections with a more virulent community-associated strain.
背景
侵袭性耐甲氧西林金黄色葡萄球菌（MRSA）和甲氧西林敏感金黄色葡萄球菌（MSSA）感染是新生儿重症监护病房（NICU）爆发的主要原因。在过去的十年中，越来越多的报道称 MRSA 在各种新生儿重症监护病房（NICU）中爆发。我们的目的是回顾过去十年中我们 NICU 中金黄色葡萄球菌败血症的经验，并描述 2000 年至 2009 年金黄色葡萄球菌血流感染发病率的趋势。
方法
对 2000 年 1 月 1 日至 2009 年 12 月 31 日期间在我们 NICU 中血培养阳性的所有新生儿进行了一项回顾性围产期数据库研究。从数据库中识别出婴儿，并收集了他们的临床特征和合并症的数据，包括败血症休克和死亡率。时期 A 代表 2000-2003 年期间入院的患者。时期 B 代表 2004-2009 年期间就诊的患者。
结果
在研究期间，156/11111 名婴儿被确定患有金黄色葡萄球菌血流感染：时期 A 中有 41/4486（0.91%）婴儿，时期 B 中有 115/6625（1.73%）（p < 0.0004）。两个时期出生时的平均胎龄均为 26 周。时期 B 中 MRSA 感染更多（24%对 55%，p < 0.05），且与更严重的结局相关。在比较两个时期观察到的 MRSA 感染病例时，时期 B 中的婴儿明显有更多的肺炎病例（2.4%对 27%，p = 0.0005）和更高的死亡率（0%对 15.7%，p = 0.0038）。两个时期皮肤和软组织感染和坏死性小肠结肠炎的发生率均无显著变化。
结论
2004 年后，新生儿金黄色葡萄球菌感染的发病率有所增加。尽管 MSSA 仍然是 NICU 的一个问题，但在过去的 6 年中，我们的 NICU 中 MRSA 感染更为普遍。葡萄球菌感染严重程度的增加和相关死亡率的上升可能与社区相关的毒力更强的 MRSA 感染增加有关。
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