Pomorska-Wesołowska Monika, Różańska Anna, Natkaniec Joanna, Gryglewska Barbara, Szczypta Anna, Dzikowska Mirosława, Chmielarczyk Agnieszka, Wójkowska-Mach Jadwiga
Department of Microbiology, Analytical and Microbiological Laboratory of Ruda Slaska, KORLAB NZOZ, Ruda Slaska, Poland.
Chair of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, 18 Czysta Street, 31-121, Krakow, Poland.
BMC Geriatr. 2017 Feb 10;17(1):51. doi: 10.1186/s12877-017-0442-3.
The proportion of older people among the general population has risen. Staphylococcus aureus (SA) constitutes a significant problem. Underlying disease and functional debility, predispose the older adult to staphylococcal carriage and infection, specially bloodstream infection and pneumonia.
This is a retrospective cohort study of older patients with SA infections. We analyzed a database containing the results of laboratory cultures from patients treated in 2013 for SA infections and selected 613 hospitalized and non-hospitalized people aged ≥60 years.
The prevalence of Methicillin-resistant SA (MRSA) were significantly different in categories of patients: from 14.1% in young old, 19.5% in old old and 26.7 in longevity. MRSA was significantly more frequently reported in cases of pneumonia, 40.4% of SA strains (p < 0.0001, OR 0.3, 95%CI 0.14-0.49). The nosocomial MRSA infections were more common in ICU departments: prevalence 36.8%, than in non-ICU departments: prevalence 17.3% (OR 2.8, 95%CI 1.06-7.34, p = 0.014). Bloodstream infections, which accounted for 6% of all infections, were more frequent in males (p = 0.0231, OR 2.25, 95%CI 1.098-4.604). The greatest increase in antibiotic resistance was related to trimethoprim/sulfamethoxazole (TMP/SXT), which increased to over 80% in the older study groups. All age groups demonstrated increased MIC90 values for glycopeptide and tigecycline. Although strains isolated from patients in all age groups remained sensitive to vancomycin, strains isolated from patients in the old-old and longevity groups demonstrated resistance to teicoplanin. The MIC90 for tigecycline was the highest in the group aged >90 years.
MRSA constitutes a significant epidemiological problem in cases of hospital-treated pneumonia. The findings were similar for long-term-care facilities, where MRSA appears to affect male residents in particular, although there were fewer male residents than female residents. The low sensitivity to TMP/SXT of SA strains isolated from the oldest patients indicates potentially serious challenges pertaining to efficacious treatment of SA infections.
普通人群中老年人的比例有所上升。金黄色葡萄球菌（SA）构成了一个重大问题。基础疾病和功能衰退使老年人易发生葡萄球菌携带和感染，尤其是血流感染和肺炎。
这是一项对老年SA感染患者的回顾性队列研究。我们分析了一个包含2013年接受SA感染治疗患者的实验室培养结果的数据库，并选择了613名年龄≥60岁的住院和非住院患者。
耐甲氧西林金黄色葡萄球菌（MRSA）的患病率在不同类别患者中存在显著差异：年轻老年人中为14.1%，老年老年人中为19.5%，长寿老年人中为26.7%。MRSA在肺炎病例中报告频率显著更高，占SA菌株的40.4%（p < 0.0001，OR 0.3，95%CI 0.14 - 0.49）。医院获得性MRSA感染在重症监护病房（ICU）更常见：患病率为36.8%，高于非ICU科室：患病率为17.3%（OR 2.8，95%CI 1.06 - 7.34，p = 0.014）。血流感染占所有感染的6%，在男性中更常见（p = 0.0231，OR 2.25，95%CI 1.098 - 4.604）。抗生素耐药性增加最多的是甲氧苄啶/磺胺甲恶唑（TMP/SXT），在老年研究组中增加到80%以上。所有年龄组的糖肽类和替加环素的MIC90值均升高。尽管从所有年龄组患者分离出的菌株对万古霉素仍敏感，但从老年老年人和长寿老年人组患者分离出的菌株对替考拉宁耐药。替加环素的MIC90在年龄>90岁的组中最高。
MRSA在医院治疗的肺炎病例中构成了重大的流行病学问题。长期护理机构的情况类似，MRSA似乎尤其影响男性居民，尽管男性居民比女性居民少。从最年长患者分离出的SA菌株对TMP/SXT敏感性低，表明在SA感染的有效治疗方面可能面临严峻挑战。
