Abeysekera Nandoun, Wong Stephen, Jackson Bryce, Buchanan Derek, Heiss-Dunlop Wolfgang, Mathy Jon A
* Auckland Regional Plastic, Reconstructive & Hand Surgery Unit, Auckland, New Zealand.
† University of Auckland School of Medicine, Auckland, New Zealand.
J Hand Surg Asian Pac Vol. 2019 Jun;24(2):129-137. doi: 10.1142/S2424835519500164.
Community Acquired Methicillin Resistant Staphylococcus aureus (CA-MRSA) rates have been increasing worldwide and contribute to a growing "global health security threat" as reported by the WHO. Our group previously reported an overall rate of 7% in CA-MRSA upper extremity infections between 2004-2009 at the Auckland Regional Hand Unit. This fell below the Center for Disease Control (CDC) recommendation for empiric antimicrobial cover once local rates exceed 10-15%. We examined prevalence and characteristics of CA-MRSA upper extremity infections in our region over a subsequent 5-year period. One thousand two hundred and fifty-two patients with upper extremity infections requiring operative management between 2011 and 2015 inclusive were included in this study. Associated clinical characteristics were recorded including ethnicity, cultured organisms, antibiotic sensitivities, infection rate, and treatment practice. One hundred and fifty (12%) of patients had culture positive CA-MRSA upper extremity infections. There was an increasing annual trend. Of note, rates of CA-MRSA in the Maori and Pacific Island ethnic subpopulations exceeded 15% in 2014 and 2015. Susceptibilities, associated factors and patient demographics are reported. Our unit enjoys significantly lower rates of CA-MRSA upper extremity infections than has been reported internationally. However, trends are increasing relative to our prior 6-year report, and the threshold for empiric treatment has been met within the Maori and Pacific Island ethnic subpopulations. This evolving threat is also highlighted by increasing cases of multi-drug resistant CA-MRSA. Evolving regional guidelines for empiric coverage of CA-MRSA among high-risk ethnic subpopulations identified by this study are underway.
社区获得性耐甲氧西林金黄色葡萄球菌（CA-MRSA）感染率在全球范围内一直在上升，正如世界卫生组织所报告的，这构成了日益严重的“全球健康安全威胁”。我们团队之前报告称，2004年至2009年期间，奥克兰地区手部单元CA-MRSA上肢感染的总体发生率为7%。一旦当地感染率超过10%-15%，这一发生率就低于疾病控制中心（CDC）关于经验性抗菌覆盖的建议。我们研究了随后5年期间本地区CA-MRSA上肢感染的患病率和特征。本研究纳入了2011年至2015年期间1252例需要手术治疗的上肢感染患者。记录了相关临床特征，包括种族、培养出的微生物、抗生素敏感性、感染率和治疗方法。150例（12%）患者的CA-MRSA上肢感染培养结果呈阳性。呈逐年上升趋势。值得注意的是，2014年和2015年，毛利族和太平洋岛民族裔亚人群中的CA-MRSA感染率超过了15%。报告了药敏情况、相关因素和患者人口统计学特征。我们科室的CA-MRSA上肢感染率明显低于国际上报告的水平。然而，与我们之前的6年报告相比，感染率呈上升趋势，并且在毛利族和太平洋岛民族裔亚人群中已经达到了经验性治疗的阈值。耐多药CA-MRSA病例的增加也凸显了这一日益严重的威胁。本研究确定的针对高危族裔亚人群的CA-MRSA经验性覆盖的区域指南正在制定中。
