Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
Harvard Medical School, Boston, Massachusetts, USA.
J Clin Microbiol. 2017 Dec 26;56(1). doi: 10.1128/JCM.01160-17. Print 2018 Jan.
The rate of infection by methicillin-resistant (MRSA) has declined over the past decade, but it is unclear whether this represents a decline in infections overall. To evaluate the trends in the annual rates of infection by subtypes and mean antibiotic resistance, we conducted a 15-year retrospective observational study at two tertiary care institutions in Boston, MA, of 31,753 adult inpatients with isolated from clinical specimens. We inferred the gain and loss of methicillin resistance through genome sequencing of 180 isolates from 2016. The annual rates of infection by declined from 2003 to 2014 by 4.2% (2.7% to 5.6%), attributable to an annual decline in MRSA of 10.9% (9.3% to 12.6%). Penicillin-susceptible (PSSA) increased by 6.1% (4.2% to 8.1%) annually, and rates of methicillin-susceptible penicillin-resistant (MSSA) did not change. Resistance in decreased from 2000 to 2014 by 0.8 antibiotics (0.7 to 0.8). Within common MRSA clonal complexes, 3/14 MSSA and 2/21 PSSA isolates arose from the loss of resistance-conferring genes. Overall, in two tertiary care institutions in Boston, MA, a decline in infections has been accompanied by a shift toward increased antibiotic susceptibility. The rise in PSSA makes penicillin an increasingly viable treatment option.
耐甲氧西林金黄色葡萄球菌（MRSA）的感染率在过去十年中有所下降，但尚不清楚这是否代表总体感染率的下降。为了评估 各亚型的年度感染率和平均抗生素耐药率的变化趋势，我们对马萨诸塞州波士顿的两家三级保健机构的 31753 例成年住院患者进行了一项为期 15 年的回顾性观察性研究，这些患者的临床标本中分离出了 。我们通过对 2016 年 180 株 的基因组测序推断出了耐甲氧西林和失去耐甲氧西林的情况。2003 年至 2014 年， 的感染率每年下降 4.2%（2.7%至 5.6%），这归因于 MRSA 每年下降 10.9%（9.3%至 12.6%）。青霉素敏感 （PSSA）每年增加 6.1%（4.2%至 8.1%），而耐甲氧西林青霉素敏感 （MSSA）的比率没有变化。从 2000 年到 2014 年， 的耐药性每年减少 0.8 种抗生素（0.7 至 0.8）。在常见的 MRSA 克隆复合体中，3/14 株 MSSA 和 2/21 株 PSSA 是由于耐药基因的丢失而产生的。总的来说，在马萨诸塞州波士顿的两家三级保健机构中， 感染的减少伴随着抗生素敏感性的提高。PSSA 的增加使得青霉素成为一种越来越可行的治疗选择。
