Coombs Geoffrey W, Daly Denise A, Pearson Julie C, Nimmo Graeme R, Collignon Peter J, McLaws Mary-Louise, Robinson James O, Turnidge John D
Australian Collaborating Centre for Enterococcus and Staphylococcus Species (ACCESS) Typing and Research, School of Biomedical Sciences, Curtin University, Perth, Western Australia and Department of Microbiology and Infectious Diseases, PathWest Laboratory Medicine-WA, Royal Perth Hospital, Perth, Western Australia.
Australian Group on Antimicrobial Resistance, Royal Perth Hospital, Perth, Western Australia.
Commun Dis Intell Q Rep. 2014 Mar 31;38(1):E59-69.
In 2012, the Australian Group on Antimicrobial Resistance (AGAR) conducted a community-onset period-prevalence survey of clinical Staphylococcus aureus isolated from hospital outpatients and general practice patients including nursing homes, long term care facilities and hospice patients. Day surgery and dialysis patients were excluded. Twenty-nine medical microbiology laboratories from all state and mainland territories participated. Isolates were tested by Vitek2® (AST-P612 card). Results were compared with previous AGAR community surveys. Nationally, the proportion of S. aureus that were methicillin-resistant S. aureus (MRSA) increased significantly from 11.5% in 2000 to 17.9% in 2012 (P<0.0001). Resistance to the non-ß-lactam antimicrobials varied between regions. No resistance was detected to vancomycin, teicoplanin or linezolid. Resistance in methicillin susceptible S. aureus was rare apart from erythromycin (12.8%) and was absent for vancomycin, teicoplanin, linezolid and daptomycin. The proportion of S. aureus characterised as health care-associated MRSA (HA-MRSA) was 5.1%. Three HA-MRSA clones were characterised, with 72.9% and 26.4% of HA-MRSA classified as ST22-IV [2B] (EMRSA-15) and ST239-III [3A] (Aus-2/3 EMRSA) respectively. Multi-clonal community-associated MRSA (CA-MRSA) accounted for 12.5% of all S. aureus. Regional variation in resistance in MRSA was primarily due to the differential distribution of the 2 major HA-MRSA clones; ST239-III [3A] (Aus-2/3 EMRSA), which is resistant to multiple non-ß-lactam antimicrobials, and ST22-IV [2B] (EMRSA-15), which is resistant to ciprofloxacin and typically erythromycin. Although the majority of CA-MRSA were non-multi-resistant, a significant expansion of Panton-Valentine leukocidin (PVL) positive CA-MRSA clones has occurred nationally. The mean age of patients (31.7 years, 95% CI 28.9-34.5) with a PVL positive CA-MRSA infection was significantly lower (P<0.0001), than the mean age of patients with a PVL negative CA-MRSA infection (55.7 years, 95% CI 50.7-60.6). This shift in the molecular epidemiology of MRSA clones in the Australian community will potentially increase the number of young Australians with skin and soft tissue infections requiring hospitalisation.
2012年，澳大利亚抗菌药物耐药性小组（AGAR）对从医院门诊患者以及包括养老院、长期护理机构和临终关怀患者在内的全科医疗患者中分离出的临床金黄色葡萄球菌进行了社区起病期间患病率调查。日间手术患者和透析患者被排除在外。来自所有州和大陆领地的29个医学微生物实验室参与了调查。分离株通过Vitek2®（AST-P612卡片）进行检测。结果与之前的AGAR社区调查进行了比较。在全国范围内，耐甲氧西林金黄色葡萄球菌（MRSA）在金黄色葡萄球菌中的比例从2000年的11.5%显著增加到2012年的17.9%（P<0.0001）。对非β-内酰胺类抗菌药物的耐药性在不同地区有所不同。未检测到对万古霉素、替考拉宁或利奈唑胺的耐药性。除红霉素（12.8%）外，甲氧西林敏感金黄色葡萄球菌的耐药性罕见，对万古霉素、替考拉宁、利奈唑胺和达托霉素均无耐药性。被归类为医疗保健相关MRSA（HA-MRSA）的金黄色葡萄球菌比例为5.1%。鉴定出了三个HA-MRSA克隆，分别有72.9%和26.4%的HA-MRSA被归类为ST22-IV [2B]（EMRSA-15）和ST239-III [3A]（Aus-2/3 EMRSA）。多克隆社区相关MRSA（CA-MRSA）占所有金黄色葡萄球菌的12.5%。MRSA耐药性的区域差异主要是由于两个主要HA-MRSA克隆的分布不同；ST239-III [3A]（Aus-2/3 EMRSA）对多种非β-内酰胺类抗菌药物耐药，ST22-IV [2B]（EMRSA-15）对环丙沙星和典型的红霉素耐药。尽管大多数CA-MRSA并非多重耐药，但全国范围内杀白细胞素（PVL）阳性CA-MRSA克隆有显著增加。PVL阳性CA-MRSA感染患者的平均年龄（31.7岁，95%可信区间28.9 - 34.5）显著低于PVL阴性CA-MRSA感染患者的平均年龄（55.7岁，95%可信区间50.7 - 60.6）（P<0.0001）。澳大利亚社区MRSA克隆分子流行病学的这种变化可能会增加需要住院治疗的澳大利亚年轻皮肤和软组织感染患者的数量。
