Rodrigues Rúben, Passadouro Rui, Gomes Odete, Castro Ricardo
Unidade de Saúde Pública. Agrupamento de Centros de Saúde do Pinhal Litoral. Leiria. Portugal.
Serviço de Medicina Intensiva. Centro Hospitalar de Leiria. Leiria. Portugal.
Acta Med Port. 2020 Mar 2;33(3):174-182. doi: 10.20344/amp.10952.
The emergence of strains of methicillin-resistant Staphylococcus aureus is a serious therapeutic challenge in healthcare provision. With this study, we aimed to investigate the risk factors and clinical outcomes (mortality and length of hospital stay) associated with methicillin-resistant Staphylococcus aureus infections in patients admitted to a district hospital in Portugal.
A case-control study was performed in 96 cases and 122 controls, selected, respectively, as function of antibiotic resistance or sensitivity to methicillin. Data were obtained through consultation of clinical records and subjected to multivariate statistical analysis.
We identified the following independent risk factors for the occurrence of methicillin-resistant Staphylococcus aureus infection: urinary catheter (aOR = 10.62, 95% CI 3.66 - 30.78), prior use of antibiotics in the last 30 days (aOR = 5.60, 95% CI 2.15 - 14.62), exposure to 5 - 7 days of hospitalization (aOR = 4.99, 95% CI 1.20 - 20.79) or to ≥ 8 days (aOR = 5.34, 95% CI 1.18 - 24.22), chronic obstructive pulmonary disease (aOR = 4.27, 95% CI 1.64 - 11.13) and recent hospitalization (aOR = 2.66, 95% CI 1.14 - 6.23). Compared to infections due to methicillin-susceptible Staphylococcus aureus, we found increased probability of having a longer hospital stay (aHR = 1.74, 95% CI 1.11 - 2.71) and in-hospital mortality was significantly higher (p = 0.001) between patients infected by methicillin-resistant Staphylococcus aureus.
The results demonstrate that methicillin resistance is associated with an increased clinical risk to patients infected by Staphylococcus aureus, in particular, a raised mortality and prolonged hospitalization.
Our study underlines the additional burden imposed by methicillin resistance in Staphylococcus aureus infections. This highlights an urgent need to reinforce and optimize prevention, control, timely detection and effective treatment strategies for multidrug--resistant Staphylococcus aureus strains.
耐甲氧西林金黄色葡萄球菌菌株的出现是医疗保健领域面临的严峻治疗挑战。通过本研究，我们旨在调查葡萄牙一家地区医院收治的患者中耐甲氧西林金黄色葡萄球菌感染的危险因素及临床结局（死亡率和住院时间）。
进行了一项病例对照研究，选取96例病例和122例对照，分别根据对甲氧西林的耐药性或敏感性进行选择。通过查阅临床记录获取数据，并进行多变量统计分析。
我们确定了耐甲氧西林金黄色葡萄球菌感染发生的以下独立危险因素：导尿管（调整后比值比[aOR]=10.62，95%置信区间[CI] 3.66 - 30.78）、过去30天内曾使用抗生素（aOR = 5.60，95% CI 2.15 - 14.62）、住院5 - 7天（aOR = 4.99，95% CI 1.20 - 20.79）或≥8天（aOR = 5.34，95% CI 1.18 - 24.22）、慢性阻塞性肺疾病（aOR = 4.27，95% CI 1.64 - 11.13）以及近期住院（aOR = 2.66，95% CI 1.14 - 6.23）。与甲氧西林敏感金黄色葡萄球菌感染相比，我们发现耐甲氧西林金黄色葡萄球菌感染患者住院时间延长的可能性增加（调整后风险比[aHR]=1.74，95% CI 1.11 - 2.71），且院内死亡率显著更高（p = 0.001）。
结果表明，甲氧西林耐药与金黄色葡萄球菌感染患者的临床风险增加相关，特别是死亡率升高和住院时间延长。
我们的研究强调了金黄色葡萄球菌感染中耐甲氧西林所带来的额外负担。这凸显了迫切需要加强和优化针对多重耐药金黄色葡萄球菌菌株的预防、控制、及时检测及有效治疗策略。
