Department of Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Department of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Microbiol Spectr. 2023 Aug 17;11(4):e0362322. doi: 10.1128/spectrum.03623-22. Epub 2023 Jun 20.
Most investigations into the distribution of methicillin resistant Staphylococcus aureus (MRSA) have focused exclusively on bloodborne infections within individual health care institutions for shorter time periods. This has limited the analysis of a community-spread pathogen to snapshots within the hospital domain. Therefore, in this study we determined the demographic and geographical patterns of MRSA infections and their fluctuation in 10 years within all public hospitals in Gauteng, South Africa. A retrospective analysis of S. aureus samples was done by deduplicating samples in two groups. The sample groups were placed into subsets with respect to demographic and geographical fields and compared across the studied period. Logistic regression was utilized to determine odds ratios for resistant infections in univariate and multivariable configurations. A total of 66,071 unique infectious events were identified from the 148,065 samples received over a 10-year period, out of which 14,356 were identified as bacteremia. MRSA bacteremia rates in Gauteng peaked in 2015 and have since decreased. Within Gauteng, metropolitan areas have the greatest burden of MRSA with children under 5 years of age and males being most affected. Medical wards have the highest S. aureus bacteremia rates, while intensive care units have the highest MRSA bacteremia rates. Patient age, admitting ward, and geographical district are the most important associated factors of resistance. MRSA acquisition rates have shown tremendous growth since 2009 but have since spiked and subsequently decreased. This may be due to the initiation of the National Guidelines on Antimicrobial Stewardship and Infectious Disease Surveillance. Further studies to determine the trajectory of infections are required to support these claims. S. aureus is the leading cause of a variety of devastating clinical conditions, including infective endocarditis, bacteremia, and pleuropulmonary infections. It is an important pathogen responsible for substantial morbidity and mortality. MRSA is a variant of interest originally responsible for difficult to treat hospital-acquired infections that has since achieved community spread throughout the world. Most investigations into the distribution of MRSA have focused exclusively on bloodborne infections within individual health care institutions for shorter periods. This has limited the analysis of a community-spread pathogen to snapshots within the hospital domain. This study sought to determine the demographic and geographical patterns of MRSA infections as well as how these have fluctuated over time within all public hospitals. This will also help in understanding the epidemiology and resistance trends of S. aureus, which will help clinicians to understand the clinical prospective and policy makers to design guidelines and strategies for treating such infections.
大多数关于耐甲氧西林金黄色葡萄球菌 (MRSA) 分布的研究都仅集中在医疗机构内的血液感染，且时间跨度较短。这限制了对社区传播病原体的分析，只能在医院范围内进行快照分析。因此，在这项研究中，我们确定了南非豪登省所有公立医院 10 年内 MRSA 感染的人口统计学和地理模式及其波动情况。通过在两组中重复样本，对金黄色葡萄球菌样本进行了回顾性分析。根据人口统计学和地理字段将样本组分为子集，并在整个研究期间进行比较。利用逻辑回归在单变量和多变量配置中确定耐药感染的优势比。在 10 年内收到的 148065 个样本中，共确定了 66071 个独特的感染事件，其中 14356 个被确定为菌血症。豪登省的 MRSA 菌血症率在 2015 年达到峰值，此后有所下降。在豪登省，大都市地区的 MRSA 负担最重，受影响最大的是 5 岁以下儿童和男性。医疗病房的金黄色葡萄球菌菌血症率最高，而重症监护病房的 MRSA 菌血症率最高。患者年龄、收治病房和地理区域是耐药的最重要相关因素。自 2009 年以来，MRSA 的获得率呈显著增长，但此后出现高峰，随后下降。这可能是由于国家抗生素管理和传染病监测指南的启动。需要进一步的研究来确定感染的轨迹，以支持这些说法。金黄色葡萄球菌是多种严重临床疾病的主要原因，包括感染性心内膜炎、菌血症和胸膜肺感染。它是一种重要的病原体，可导致严重的发病率和死亡率。MRSA 是一种变体，最初是引起难以治疗的医院获得性感染的原因，此后已在全球范围内传播到社区。大多数关于 MRSA 分布的研究都仅集中在医疗机构内的血液感染，且时间跨度较短。这限制了对社区传播病原体的分析，只能在医院范围内进行快照分析。这项研究旨在确定 MRSA 感染的人口统计学和地理模式，以及这些模式在所有公立医院内随时间的波动情况。这也将有助于了解金黄色葡萄球菌的流行病学和耐药趋势，这将帮助临床医生了解临床前景，政策制定者为治疗此类感染制定指南和策略。
