社区获得性肺炎中的耐甲氧西林金黄色葡萄球菌：危险因素和结局。
Methicillin-susceptible staphylococcus aureus in community-acquired pneumonia: Risk factors and outcomes.
机构信息
Department of Pneumology, Hospital Clinic of Barcelona, August Pi i Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona, Biomedical Research Networking Centers in Respiratory Diseases (CIBERES) Barcelona, C/ Villarroel 170, 08036 Barcelona, Spain.
Department of Shock e Trauma, San Camillo Forlanini Hospital, Rome, Italy.
出版信息
J Infect. 2021 Jan;82(1):76-83. doi: 10.1016/j.jinf.2020.10.032. Epub 2020 Nov 2.
OBJECTIVES
We aimed to describe the prevalence, risk factors and outcomes of Methicillin-susceptible S. aureus (MSSA) community-acquired pneumonia (CAP) and compare them with those associated with CAP due to Streptococcus pneumoniae, the most frequent causative microorganism, in a large cohort of patients.
METHODS
This was an observational study of prospectively collected data of consecutive adults with CAP and a definitive etiology enrolled between 2004 and 2018. Patients were divided into MSSA CAP and pneumococcal CAP groups for analysis.
RESULTS
A microbial etiology was established in 1,548 (33%) cases: S. aureus caused 6% of microbiologically-confirmed CAP cases. In the latter, 52 were due to MSSA (60% of S. aureus CAP cases, and 3% of microbiologically-confirmed CAP cases) and 34 were due to MRSA (40% of S. aureus CAP cases, and 2% of microbiologically-confirmed CAP cases). S. pneumoniae was identified in 734 (47%) microbiologically-confirmed CAP cases. The presence of fever was independently associated with a lower risk of MSSA CAP (OR 0.53; 95% CI, 0.28-0.99). Patients with MSSA CAP had higher 30-day mortality than patients with pneumococcal CAP, both before and after adjustment for potential confounders (21% vs 7%, p = 0.002). MSSA was independently associated with 30-day mortality in the overall population.
CONCLUSION
MSSA CAP was associated with worse outcomes than pneumococcal CAP in our cohort. MSSA was an independent factor of mortality.
目的
我们旨在描述耐甲氧西林金黄色葡萄球菌（MSSA）社区获得性肺炎（CAP）的患病率、危险因素和结局，并将其与最常见病原体肺炎链球菌所致 CAP 进行比较，这是在一大群患者中进行的观察性研究。
方法
这是一项前瞻性收集 2004 年至 2018 年间连续患有 CAP 和明确病因的成年患者数据的观察性研究。患者被分为 MSSA CAP 和肺炎球菌 CAP 组进行分析。
结果
微生物病因在 1548 例（33%）病例中得到证实：金黄色葡萄球菌引起 6%的微生物学确诊 CAP 病例。在后者中，52 例为 MSSA（金黄色葡萄球菌 CAP 病例的 60%，微生物学确诊 CAP 病例的 3%），34 例为 MRSA（金黄色葡萄球菌 CAP 病例的 40%，微生物学确诊 CAP 病例的 2%）。734 例微生物学确诊 CAP 病例中鉴定出肺炎链球菌。发热的存在与 MSSA CAP 的风险降低独立相关（OR 0.53；95%CI，0.28-0.99）。在调整潜在混杂因素之前和之后，MSSA CAP 患者的 30 天死亡率均高于肺炎球菌 CAP 患者（21%比 7%，p=0.002）。MSSA 在总体人群中与 30 天死亡率独立相关。
结论
在我们的队列中，MSSA CAP 与肺炎球菌 CAP 相比，其结局更差。MSSA 是死亡率的独立因素。
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