韩国长达 11 年的成人菌血症患者的纵向研究。
A Longitudinal Study of Adult Patients with Bacteremia over 11 Years in Korea.
机构信息
Division of Infectious Diseases, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.
Division of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
出版信息
J Korean Med Sci. 2021 Apr 26;36(16):e104. doi: 10.3346/jkms.2021.36.e104.
BACKGROUND
The temporal changes in the genotypes causing bacteremia (SAB) and the corresponding clinical changes over the last decade in South Korea are rarely investigated.
METHODS
A longitudinal study of adult SAB patients was conducted in a large referral hospital in Seoul, South Korea. Adult monomicrobial SAB patients were enrolled between August 2008 and December 2018. Genotyping was performed by multilocus sequence typing (MLST) and staphylococcal protein A () typing. Trends in changes were identified by linear regression analysis.
RESULTS
Of 1782 adult SAB patients, the blood isolates of 1,778 (99.8%) and 1,634 (91.7%) were determined to be MLST and type, respectively. ST5 (-2.626%/year) and ST239 (-0.354%/year) decreased during the study period ( < 0.001 for both), but ST72 (2.009%/yr)-and ST8 (0.567%/yr) increased ( < 0.001 for both). The most common genotype was changed from ST5 in 2008 (44.9%) to ST72 in 2018 (36.3%). Panton-Valentine leukocidin-positive -t008-MRSA (USA300) was found in 28.6%. Central venous catheter (CVC)-related SAB (-2.440%/yr) and persistent SAB (-1.016%/yr) decreased, but mortality and recurrence rates were unchanged.
CONCLUSION
Over the last decade, the hospital clones ST5 and ST239 have been replaced by community genotype ST72. This was associated with decreased CVC-related and persistent SAB. Increased USA300 was observed in community and hospital settings. Further research is required to identify the reasons for the ST72 epidemic and predict the impending epidemic of ST8 strains, including USA300.
背景
过去十年中，韩国很少有研究调查导致菌血症（SAB）的基因型的时间变化以及相应的临床变化。
方法
在韩国首尔的一家大型转诊医院进行了一项成人 SAB 患者的纵向研究。2008 年 8 月至 2018 年 12 月期间，招募了成人单一致病菌血症患者。通过多位点序列分型（MLST）和葡萄球菌蛋白 A（spa）分型进行基因分型。通过线性回归分析确定变化趋势。
结果
在 1782 例成人 SAB 患者中，1778 例（99.8%）和 1634 例（91.7%）的血液分离株分别确定为 MLST 和 spa 型。ST5（-2.626%/年）和 ST239（-0.354%/年）在研究期间减少（均<0.001），但 ST72（2.009%/年）和 ST8（0.567%/年）增加（均<0.001）。最常见的基因型从 2008 年的 ST5（44.9%）变为 2018 年的 ST72（36.3%）。发现 28.6%的产 Panton-Valentine 白细胞毒素阳性 -t008-MRSA（USA300）。中心静脉导管（CVC）相关 SAB（-2.440%/年）和持续 SAB（-1.016%/年）减少，但死亡率和复发率不变。
结论
在过去十年中，医院克隆 ST5 和 ST239 已被社区基因型 ST72 取代。这与 CVC 相关和持续 SAB 的减少有关。在社区和医院环境中观察到 USA300 的增加。需要进一步研究以确定 ST72 流行的原因，并预测即将出现的 ST8 菌株流行，包括 USA300。
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