医院中社区获得性耐甲氧西林金黄色葡萄球菌感染：年龄特异性及潜在的人畜共患病-人兽共患病传播动态

Community-Acquired Methicillin-Resistant in Hospitals: Age-Specificity and Potential Zoonotic-Zooanthroponotic Transmission Dynamics.

作者信息

Alsolami Ahmed, ALGhasab Naif Saad, Alharbi Mohammed S M, Bashir Abdelhafiz I, Saleem Mohd, Syed Khaja Azharuddin Sajid, Aldakheel Dakheel F, Rakha Ehab, Alshammari Jabar Aziz, Taha Taha E, Melibari Ziyad, Alharbi Yaseer H, Almutlag Ali A, Said Kamaleldin B

机构信息

Department of Internal Medicine, College of Medicine, University of Ha'il, Ha'il 55476, Saudi Arabia.

Department of Cardiology, College of Medicine, University of Ha'il, Ha'il 55476, Saudi Arabia.

出版信息

Diagnostics (Basel). 2023 Jun 16;13(12):2089. doi: 10.3390/diagnostics13122089.

DOI:10.3390/diagnostics13122089

PMID:37370983

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10297644/

Abstract

Methicillin-resistant (MRSA) lineages are a devastating clinical and public health issue. Data on local lineage profiles are limited. We report on the frequency of community-acquired and hospital-acquired cases (CA-MRSA, HA-MRSA). We studied 147 isolates from King Khalid tertiary care hospitals (KKH), each from a case in a patient and including 33 patients at the Maternity and Children's Hospital (MCH). Of the 147 isolates, 87 males (59%) and 60 females (41%) were in KKH. The overwhelming majority (80%; = 119/147) were CA-MRSA in KKH. Intriguingly, despite significant differences between males (70%) and females (53%), lineage-acquisition remained age-specific around 58-60 years in both genders. However, while CA-MRSA dominated early in life (0-20, 70% MCH), it increased with age in KKH adults; 21-50 (28%), >50 (59%) until the overall 80% ( = 144/180). Major specimens included skin-wounds, surgeries (70.3%), blood (13.5%), sputum (8.8%), very rarely urine (4.1%), and nasal (3.4%), albeit most patients showed severe enteritis and necrotizing pneumonia. Antibiograms showed high beta lactam resistances, including amoxicillin-clavulanate (83%), oxacillin (84%), cefoxitin FOX (100%), penicillin and ampicillin (~100%), as well as high resistance (82%) to carbapenem. Fortunately, high susceptibility was seen to non-beta lactams and, to a lesser extent, gentamicin, erythromycin, and fusidic acid; 33%, 34%, and 38%, respectively, in KKH. A similar pattern was seen in MCH except for a low resistance pattern to gentamicin CN, clindamycin CD, erythromycin E, and tobramycin TOB; 34%, 31%, 39%, and 41%, respectively, except for fusidic acid. These findings have significant clinical implications for MRSA patient management strategies. Clinical- and lineage-profiles imply host-selection and zoonotic-zooanthroponotic transmission dynamics. Future molecular typing, sequencing, and characterization of dominant clone(s) is imperative.

摘要

耐甲氧西林金黄色葡萄球菌（MRSA）谱系是一个极具破坏性的临床和公共卫生问题。关于当地谱系概况的数据有限。我们报告了社区获得性和医院获得性病例（CA-MRSA、HA-MRSA）的发生频率。我们研究了来自哈立德国王三级护理医院（KKH）的147株分离菌，每株分离菌均来自一名患者，其中包括33名在妇幼医院（MCH）的患者。在这147株分离菌中，KKH有87名男性（59%）和60名女性（41%）。在KKH，绝大多数（80%；119/147）为CA-MRSA。有趣的是，尽管男性（70%）和女性（53%）之间存在显著差异，但谱系获得在两性中均在58 - 60岁左右呈现年龄特异性。然而，虽然CA-MRSA在生命早期（0 - 20岁）占主导（MCH中为70%），但在KKH的成年人中随年龄增加；21 - 50岁（28%）、>50岁（59%），直至总体达到80%（144/180）。主要标本包括皮肤伤口、手术（70.3%）、血液（13.5%）、痰液（8.8%），尿液（4.1%）和鼻腔（3.4%）非常少见，尽管大多数患者表现出严重肠炎和坏死性肺炎。抗菌谱显示对β-内酰胺类药物有高耐药性，包括阿莫西林-克拉维酸（83%）、苯唑西林（84%）、头孢西丁FOX（100%）、青霉素和氨苄西林（~100%），以及对碳青霉烯类药物有高耐药性（82%）。幸运的是，对非β-内酰胺类药物以及程度稍低的庆大霉素、红霉素和夫西地酸有高敏感性；在KKH中分别为33%、34%和38%。在MCH中也观察到类似模式，但对庆大霉素CN、克林霉素CD、红霉素E和妥布霉素TOB的耐药模式较低；分别为34%、31%、39%和41%，夫西地酸除外。这些发现对MRSA患者管理策略具有重要的临床意义。临床和谱系概况暗示了宿主选择以及人畜共患病-人兽共患病传播动态。未来对优势克隆进行分子分型、测序和特征分析势在必行。