Cluzet Valerie C, Gerber Jeffrey S, Nachamkin Irving, Metlay Joshua P, Zaoutis Theoklis E, Davis Meghan F, Julian Kathleen G, Linkin Darren R, Coffin Susan E, Margolis David J, Hollander Judd E, Bilker Warren B, Han Xiaoyan, Mistry Rakesh D, Gavin Laurence J, Tolomeo Pam, Wise Jacqueleen A, Wheeler Mary K, Hu Baofeng, Fishman Neil O, Royer David, Lautenbach Ebbing
1Division of Infectious Diseases,Department of Medicine,Perelman School of Medicine,University of Pennsylvania,Philadelphia,Pennsylvania.
2Center for Clinical Epidemiology and Biostatistics,Perelman School of Medicine, University of Pennsylvania,Philadelphia,Pennsylvania.
Infect Control Hosp Epidemiol. 2015 Jul;36(7):786-93. doi: 10.1017/ice.2015.76. Epub 2015 Apr 14.
OBJECTIVE To identify risk factors for recurrent methicillin-resistant Staphylococcus aureus (MRSA) colonization. DESIGN Prospective cohort study conducted from January 1, 2010, through December 31, 2012. SETTING Five adult and pediatric academic medical centers. PARTICIPANTS Subjects (ie, index cases) who presented with acute community-onset MRSA skin and soft-tissue infection. METHODS Index cases and all household members performed self-sampling for MRSA colonization every 2 weeks for 6 months. Clearance of colonization was defined as 2 consecutive sampling periods with negative surveillance cultures. Recurrent colonization was defined as any positive MRSA surveillance culture after clearance. Index cases with recurrent MRSA colonization were compared with those without recurrence on the basis of antibiotic exposure, household demographic characteristics, and presence of MRSA colonization in household members. RESULTS The study cohort comprised 195 index cases; recurrent MRSA colonization occurred in 85 (43.6%). Median time to recurrence was 53 days (interquartile range, 36-84 days). Treatment with clindamycin was associated with lower risk of recurrence (odds ratio, 0.52; 95% CI, 0.29-0.93). Higher percentage of household members younger than 18 was associated with increased risk of recurrence (odds ratio, 1.01; 95% CI, 1.00-1.02). The association between MRSA colonization in household members and recurrent colonization in index cases did not reach statistical significance in primary analyses. CONCLUSION A large proportion of patients initially presenting with MRSA skin and soft-tissue infection will have recurrent colonization after clearance. The reduced rate of recurrent colonization associated with clindamycin may indicate a unique role for this antibiotic in the treatment of such infection.
目的 确定耐甲氧西林金黄色葡萄球菌（MRSA）复发性定植的危险因素。设计 2010年1月1日至2012年12月31日进行的前瞻性队列研究。地点 五家成人及儿科学术医疗中心。参与者 出现急性社区获得性MRSA皮肤及软组织感染的受试者（即索引病例）。方法 索引病例及所有家庭成员每2周进行一次MRSA定植的自我采样，共6个月。定植清除定义为连续2个采样期监测培养结果为阴性。复发性定植定义为清除后任何一次MRSA监测培养结果为阳性。将复发性MRSA定植的索引病例与未复发的病例在抗生素暴露、家庭人口统计学特征以及家庭成员中MRSA定植情况方面进行比较。结果 研究队列包括195例索引病例；85例（43.6%）出现复发性MRSA定植。复发的中位时间为53天（四分位间距，36 - 84天）。克林霉素治疗与较低的复发风险相关（比值比，0.52；95%置信区间，0.29 - 0.93）。18岁以下家庭成员比例较高与复发风险增加相关（比值比，1.01；95%置信区间，1.00 - 1.02）。在初步分析中，家庭成员中MRSA定植与索引病例复发性定植之间的关联未达到统计学显著性。结论 很大一部分最初表现为MRSA皮肤及软组织感染的患者在清除后会出现复发性定植。与克林霉素相关的复发性定植率降低可能表明该抗生素在治疗此类感染中具有独特作用。
