Walter Jan, Noll Ines, Feig Marcel, Weiss Bettina, Claus Hermann, Werner Guido, Eckmanns Tim, Hermes Julia, Abu Sin Muna
Robert Koch Institute, Department for Infectious Disease Epidemiology, Postfach 65 02 61, D-13302, Berlin, Germany.
National Reference Centre for Staphylococci and Enterococci; Unit 13 Nosocomial Pathogens and Antibiotic Resistances; Robert Koch Institute, Burgstr. 37, D-38855, Wernigerode, Germany.
BMC Infect Dis. 2017 Feb 23;17(1):169. doi: 10.1186/s12879-017-2271-6.
Recent analysis of trends of non-invasive infections with methicillin resistant Staphylococcus aureus (MRSA), of trends of MRSA infections in outpatient settings and of co-resistance profiles of MRSA isolates are scarce or lacking in Germany.
We analysed data from the Antimicrobial Resistance Surveillance Network (ARS). We included in the analysis the first isolate of S. aureus per patient and year, which had a valid test result for oxacillin resistance and which was not a screening sample. We limited the analysis to isolates from facilities, which contributed to ARS for all six years between 2010 and 2015. We compared the proportion of methicillin resistance among S. aureus isolates by calendar year using Chi-square and Fisher's exact test. We corrected for multiple testing using the Bonferroni correction. We stratified the analysis by sample type including various non-invasive sample types and by type of care (e.g. hospital versus outpatient clinic). We also analysed the non-susceptibility of MRSA to selected antibiotics.
The analysis included 148,561 S. aureus isolates. The distribution of these isolates by sex, age, region, sample type, clinical speciality and type of care remained relatively stable over the six years analysed. The proportion of MRSA among S. aureus isolates decreased continuously from 16% in 2010 to 10% in 2015. This decrease was seen for all types of care and for the majority of sample types, including the outpatient clinic (12 to 8%), as well as blood culture (19 to 9%), urine samples (25 to 15%), swabs (14 to 9%), respiratory samples (22 to 11%) and lesions (15 to 10%). The non-susceptibility of MRSA isolates to tobramycin (47 to 32%), ciprofloxacin (95 to 89%), moxifloxacin (94 to 84%), clindamycin (80 to 71%) and erythromycin (81 to 72%) declined markedly, but it increased for tetracyclines (6 to 9%) and gentamicin (3 to 6%). Non-susceptibility of MRSA to linezolid, teicoplanin, tigecycline and vancomycin remained rare.
This analysis indicates that the incidence of MRSA infections declined in a variety of settings in Germany between 2010 and 2015 and that the co-resistance profiles of MRSA isolates changed markedly.
在德国，对耐甲氧西林金黄色葡萄球菌（MRSA）的非侵袭性感染趋势、门诊环境中MRSA感染趋势以及MRSA分离株的共同耐药谱的近期分析很少或缺乏。
我们分析了抗菌药物耐药监测网络（ARS）的数据。分析纳入了每位患者每年的第一株金黄色葡萄球菌分离株，该分离株对苯唑西林耐药有有效检测结果且不是筛查样本。我们将分析限于2010年至2015年这六年期间向ARS提供数据的机构的分离株。我们使用卡方检验和费舍尔精确检验按日历年比较金黄色葡萄球菌分离株中甲氧西林耐药的比例。我们使用邦费罗尼校正对多重检验进行校正。我们按样本类型（包括各种非侵袭性样本类型）和护理类型（如医院与门诊诊所）对分析进行分层。我们还分析了MRSA对选定抗生素的不敏感性。
分析纳入了148,561株金黄色葡萄球菌分离株。在分析的六年中，这些分离株按性别、年龄、地区、样本类型、临床专科和护理类型的分布保持相对稳定。金黄色葡萄球菌分离株中MRSA的比例从2010年的16%持续下降至2015年的10%。在所有护理类型和大多数样本类型中均出现这种下降，包括门诊诊所（从12%降至8%）以及血培养（从19%降至9%）、尿液样本（从25%降至15%）、拭子（从14%降至9%）、呼吸道样本（从22%降至11%）和病变样本（从15%降至10%）。MRSA分离株对妥布霉素（从47%降至32%）、环丙沙星（从95%降至89%）、莫西沙星（从94%降至84%）、克林霉素（从80%降至71%）和红霉素（从81%降至72%）的不敏感性显著下降，但对四环素（从6%升至9%）和庆大霉素（从3%升至6%）的不敏感性增加。MRSA对利奈唑胺、替考拉宁、替加环素和万古霉素的不敏感性仍然罕见。
该分析表明，2010年至2015年期间德国多种环境中MRSA感染的发病率下降，且MRSA分离株的共同耐药谱发生了显著变化。
