Department of Epidemiology and Health Statistics, Guangdong Pharmaceutical University, Guangzhou 510310, China.
School of Population Health, The University of New South Wales, Sydney, Australia.
J Infect Public Health. 2020 Nov;13(11):1742-1748. doi: 10.1016/j.jiph.2020.09.011. Epub 2020 Oct 11.
Coagulase-negative Staphylococci (CoNS) are opportunistic pathogens. Methicillin-resistant CoNS (MRCoNS) remain a major cause of nosocomial infections, but limited information is available in communities. We, therefore, aimed to investigate the epidemiology of CoNS nasal carriage, especially MRCoNS in community-based drug users.
Drug users were included in the cross-sectional study from three communities in Guangzhou, China. A face-to-face questionnaire was used to collect individual information and nasal swabs were collected to identify CoNS and MRCoNS isolates. Phenotypic and genotypic characterization of MRCoNS isolates were detected by using the disk diffusion method and polymerase chain reaction assays. Factors impacting MRCoNS carriage were assessed and estimated odds ratios (ORs) and 95% confidence intervals (CIs) by using logistic regression models.
Overall, 353 drug users were eligible and included in the study. The prevalence of CoNS and MRCoNS were 42.78% and 29.18%, respectively. Having a history of being in prison (aOR = 2.16, 95% CI: 1.10-4.22) and a history of heroin snorting in the past 6 months (aOR = 1.87, 95% CI: 1.14-3.05) were risk factors for MRCoNS nasal carriage in drug users. The proportions of multidrug resistance for CoNS and MRCoNS isolates were respectively 54.38% and 66.07%. The predominant multidrug resistance pattern for CoNS and MRCoNS isolates was simultaneously non-susceptible to penicillin, cefoxitin and trimethoprim-sulfamethoxazole. MRCoNS isolates that were positive for erythromycin- (χ = 15.49, P < 0.001), tetracycline- (χ = 44.88, P < 0.001), penicillin- (χ = 3.86, P = 0.049), clindamycin- (χ = 4.18, P = 0.028), and gentamicin- (χ = 20.66, P < 0.001) resistance genes had significantly higher rates of resistance to corresponding antibiotics.
The prevalence of MRCoNS nasal carriage was high in community-based drug users. Drug users with risk factors should be paid greater attention to. The use of antibiotics in drug users needs further investigation and control.
凝固酶阴性葡萄球菌（CoNS）是机会性病原体。耐甲氧西林凝固酶阴性葡萄球菌（MRCoNS）仍然是医院感染的主要原因，但在社区中可用的信息有限。因此，我们旨在研究社区为基础的药物使用者中凝固酶阴性葡萄球菌鼻腔携带，特别是耐甲氧西林凝固酶阴性葡萄球菌的流行病学。
从中国广州的三个社区中纳入了这项横断面研究的药物使用者。使用面对面的问卷收集个人信息，并收集鼻腔拭子以鉴定凝固酶阴性葡萄球菌和耐甲氧西林凝固酶阴性葡萄球菌分离株。使用纸片扩散法和聚合酶链反应检测耐甲氧西林凝固酶阴性葡萄球菌分离株的表型和基因型特征。通过使用逻辑回归模型评估影响耐甲氧西林凝固酶阴性葡萄球菌携带的因素，并估计比值比（OR）和 95％置信区间（CI）。
总体而言，有 353 名药物使用者符合条件并被纳入研究。凝固酶阴性葡萄球菌和耐甲氧西林凝固酶阴性葡萄球菌的患病率分别为 42.78％和 29.18％。有入狱史（OR = 2.16，95％CI：1.10-4.22）和过去 6 个月内有海洛因鼻吸史（OR = 1.87，95％CI：1.14-3.05）是药物使用者耐甲氧西林凝固酶阴性葡萄球菌鼻腔携带的危险因素。凝固酶阴性葡萄球菌和耐甲氧西林凝固酶阴性葡萄球菌分离株的多药耐药比例分别为 54.38％和 66.07％。凝固酶阴性葡萄球菌和耐甲氧西林凝固酶阴性葡萄球菌分离株的主要多药耐药模式是同时对青霉素、头孢西丁和甲氧苄啶-磺胺甲恶唑不敏感。红霉素（χ = 15.49，P <0.001）、四环素（χ = 44.88，P <0.001）、青霉素（χ = 3.86，P = 0.049）、克林霉素（χ = 4.18，P = 0.028）和庆大霉素（χ = 20.66，P <0.001）耐药基因阳性的耐甲氧西林凝固酶阴性葡萄球菌分离株对相应抗生素的耐药率显著更高。
社区为基础的药物使用者中耐甲氧西林凝固酶阴性葡萄球菌鼻腔携带率很高。应更加关注有危险因素的药物使用者。需要进一步调查和控制药物使用者中抗生素的使用。
