School of Medicine, Chang Gung University, Kweishan, Taoyuan, Taiwan.
School of Medicine, Chang Gung University, Kweishan, Taoyuan, Taiwan; Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Kweishan, Taoyuan, Taiwan.
J Microbiol Immunol Infect. 2020 Apr;53(2):292-299. doi: 10.1016/j.jmii.2018.03.005. Epub 2018 Jun 4.
To evaluate the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) nasal carriage in patients with diabetic foot ulcer (DFU) in Taiwan, and to assess the concordance between colonizing and clinical MRSA isolates from the patients.
A total of 354 nasal specimens were collected from 112 to 242 diabetic patients with and without foot ulcer, respectively. MRSA clinical isolates from DFU wound cultures were collected for comparison.
Nasal carriage rate of S. aureus and MRSA was similar between diabetic patients with and without foot ulcer (15.2% vs. 16.9% for S. aureus and 5.4% vs. 1.7% for MRSA). Nasal S. aureus colonization was an independent predictor for wound S. aureus infection (Odds ratio [OR]: 5.33, 95% confidence interval [CI]: 1.61-17.59), so did nasal MRSA colonization (OR: 19.09, 95% CI: 2.12-171.91). The levels of glycated hemoglobin, and the usage with immunosuppressant agent were associated with S. aureus nasal colonization while oral hypoglycemic agent usage a protective factor. Sequence type 59/staphylococcal chromosome cassette mec IV or V, the local endemic community-associated clone, accounted for 42% and 70% of the clinical and colonizing isolates, respectively. Six of 10 patients with paired colonizing and clinical isolates, either MRSA or methicillin-sensitive S. aureus, had a genetically identical strain from a single patient.
Less than one-fifth of patients with DFU have nasal S. aureus, including MRSA, colonization; however, the colonization is significantly associated with S. aureus diabetic foot infection. Screening for S. aureus colonizing status in DFU patients might have a potential clinical implication.
评估耐甲氧西林金黄色葡萄球菌（MRSA）在台湾地区糖尿病足溃疡（DFU）患者鼻腔携带的流行率，并评估患者定植和临床 MRSA 分离株之间的一致性。
从 112 至 242 例分别患有和不患有足部溃疡的糖尿病患者中采集了 354 份鼻腔标本。采集 DFU 伤口培养物中的 MRSA 临床分离株进行比较。
患有和不患有足部溃疡的糖尿病患者中金黄色葡萄球菌和 MRSA 的鼻腔携带率相似（金黄色葡萄球菌为 15.2%比 16.9%，MRSA 为 5.4%比 1.7%）。鼻腔金黄色葡萄球菌定植是伤口金黄色葡萄球菌感染的独立预测因子（优势比 [OR]：5.33，95%置信区间 [CI]：1.61-17.59），鼻腔 MRSA 定植也是如此（OR：19.09，95% CI：2.12-171.91）。糖化血红蛋白水平和免疫抑制剂的使用与金黄色葡萄球菌鼻腔定植有关，而口服降糖药的使用是保护因素。序列类型 59/葡萄球菌染色体盒 mecIV 或 V，即地方性社区相关克隆，分别占临床和定植分离株的 42%和 70%。10 例具有配对定植和临床分离株的患者中，6 例 MRSA 或甲氧西林敏感金黄色葡萄球菌患者的单一患者具有遗传上相同的菌株。
不到五分之一的 DFU 患者存在金黄色葡萄球菌，包括 MRSA，定植；然而，定植与金黄色葡萄球菌糖尿病足感染显著相关。在 DFU 患者中筛查金黄色葡萄球菌定植状态可能具有潜在的临床意义。
