Coombs Geoffrey W, Daley Denise A, Thin Lee Yung, Pearson Julie C, Robinson J Owen, Nimmo Graeme R, Collignon Peter, Howden Benjamin P, Bell Jan M, Turnidge John D
Australian Collaborating Centre for Enterococcus and Staphylococcus Species (ACCESS) Typing and Research, School of Veterinary and Life Sciences, Murdoch University, Murdoch, Western Australia.
Department of Microbiology and Infectious Diseases, PathWest Laboratory Medicine-WA, Fiona Stanley Hospital, Murdoch, Western Australia.
Commun Dis Intell Q Rep. 2016 Jun 30;40(2):E244-54.
From 1 January to 31 December 2014, 27 institutions around Australia participated in the Australian Staphylococcal Sepsis Outcome Programme (ASSOP). The aim of ASSOP 2014 was to determine the proportion of Staphylococcus aureus bacteraemia (SAB) isolates in Australia that are antimicrobial resistant, with particular emphasis on susceptibility to methicillin and to characterise the molecular epidemiology of the isolates. Overall, 18.8% of the 2,206 SAB episodes were methicillin resistant, which was significantly higher than that reported in most European countries. The 30-day all-cause mortality associated with methicillin-resistant SAB was 23.4%, which was significantly higher than the 14.4% mortality associated with methicillin-sensitive SAB (P <0.0001). With the exception of the beta-lactams and erythromycin, antimicrobial resistance in methicillin-sensitive S. aureus remains rare. However in addition to the beta-lactams, approximately 50‰ of methicillin-resistant S. aureus (MRSA) were resistant to erythromycin and ciprofloxacin and approximately 15% were resistant to co-trimoxazole, tetracycline and gentamicin. When applying the European Committee on Antimicrobial Susceptibility Testing breakpoints, teicoplanin resistance was detected in 2 S. aureus isolates. Resistance was not detected for vancomycin or linezolid. Resistance to non-beta-lactam antimicrobials was largely attributable to 2 healthcare-associated MRSA clones; ST22-IV [2B] (EMRSA-15) and ST239-III [3A] (Aus-2/3 EMRSA). ST22-IV [2B] (EMRSA-15) has become the predominant healthcare associated clone in Australia. Sixty per cent of methicillin-resistant SAB were due to community-associated (CA) clones. Although polyclonal, almost 44% of community-associated clones were characterised as ST93-IV [2B] (Queensland CA-MRSA) and ST1-IV [2B] (WA1). CA-MRSA, in particular the ST45-V [5C2&5] (WA84) clone, has acquired multiple antimicrobial resistance determinants including ciprofloxacin, erythromycin, clindamycin, gentamicin and tetracycline. As CA-MRSA is well established in the Australian community it is important that antimicrobial resistance patterns in community and healthcare-associated SAB is monitored as this information will guide therapeutic practices in treating S. aureus sepsis.
2014年1月1日至12月31日，澳大利亚各地的27家机构参与了澳大利亚葡萄球菌败血症结局项目（ASSOP）。2014年ASSOP的目标是确定澳大利亚耐抗菌药物的金黄色葡萄球菌菌血症（SAB）分离株的比例，特别关注对甲氧西林的敏感性，并对分离株的分子流行病学特征进行描述。总体而言，在2206例SAB病例中，18.8%为耐甲氧西林菌株，这一比例显著高于大多数欧洲国家报告的比例。耐甲氧西林SAB的30天全因死亡率为23.4%，显著高于甲氧西林敏感SAB的14.4%死亡率（P<0.0001）。除β-内酰胺类和红霉素外，甲氧西林敏感金黄色葡萄球菌的抗菌药物耐药性仍然罕见。然而，除β-内酰胺类外，约50‰的耐甲氧西林金黄色葡萄球菌（MRSA）对红霉素和环丙沙星耐药，约15%对复方新诺明、四环素和庆大霉素耐药。应用欧洲抗菌药物敏感性试验委员会的断点标准时，在2株金黄色葡萄球菌分离株中检测到替考拉宁耐药。未检测到对万古霉素或利奈唑胺的耐药性。对非β-内酰胺类抗菌药物的耐药性主要归因于2个与医疗保健相关的MRSA克隆；ST22-IV [2B]（EMRSA-15）和ST239-III [3A]（Aus-2/3 EMRSA）。ST22-IV [2B]（EMRSA-15）已成为澳大利亚与医疗保健相关的主要克隆株。60%的耐甲氧西林SAB归因于社区相关（CA）克隆。尽管是多克隆的，但几乎44%的社区相关克隆被鉴定为ST93-IV [2B]（昆士兰CA-MRSA）和ST1-IV [2B]（WA1）。CA-MRSA，特别是ST45-V [5C2&5]（WA84）克隆，已获得多种抗菌药物耐药决定因素，包括环丙沙星、红霉素、克林霉素、庆大霉素和四环素。由于CA-MRSA在澳大利亚社区中已广泛存在，因此监测社区和医疗保健相关SAB中的抗菌药物耐药模式非常重要，因为这些信息将指导治疗金黄色葡萄球菌败血症的治疗实践。
