Bouiller Kevin, Jacko Natasia F, Shumaker Margot J, Talbot Brooke M, Read Timothy D, David Michael Z
Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
Université de Franche-Comté, CHU Besançon, UMR-CNRS 6249 Chrono-environnement, Department of Infectious and Tropical Diseases, Besançon, France.
Front Immunol. 2024 Feb 16;15:1335867. doi: 10.3389/fimmu.2024.1335867. eCollection 2024.
We aimed to compare patient characteristics, MRSA sequence types, and biofilm production of MRSA strains that did and did not cause a foreign body infection in patients with MRSA bloodstream infections (BSI).
All adult patients with MRSA BSI hospitalized in two hospitals were identified by clinical microbiology laboratory surveillance. Only patients who had at least one implanted foreign body during the episode of BSI were included.
In July 2018 - March 2022, of 423 patients identified with MRSA BSI, 118 (28%) had ≥1 foreign body. Among them, 51 (43%) had one or more foreign body infections. In multivariable analysis, factors associated with foreign body infection were history of MRSA infection in the last year (OR=4.7 [1.4-15.5], p=0.012) community-associated BSI (OR=68.1 [4.2-1114.3], p=0.003); surgical site infection as source of infection (OR=11.8 [2-70.4], p=0.007); presence of more than one foreign body (OR=3.4 [1.1-10.7], p=0.033); interval between foreign body implantation and infection <18 months (OR=3.3 [1.1-10], p=0.031); and positive blood culture ≥48h (OR=16.7 [4.3-65.7], p<0.001). The most prevalent sequence type was ST8 (39%), followed by ST5 (29%), and ST105 (20%) with no significant difference between patients with or without foreign body infection. Only 39% of MRSA isolates formed a moderate/strong biofilm. No significant difference was observed between patients with foreign body infection and those without foreign body infection. In multivariable analysis, subjects infected with a MRSA isolate producing moderate/strong biofilm were more likely to have a history of MRSA infection in the last year (OR=3.41 [1.23-9.43]), interval between foreign body implantation and MRSA BSI <18 months (OR=3.1 [1.05-9.2]) and ST8 (OR=10.64 [2-57.3]).
Most factors associated with foreign body infection in MRSA BSI were also characteristic of persistent infections. Biofilm-forming isolates were not associated with a higher risk of foreign-body infection but appeared to be associated with MRSA genetic lineage, especially ST8.
我们旨在比较耐甲氧西林金黄色葡萄球菌血流感染（BSI）患者中，导致或未导致异物感染的耐甲氧西林金黄色葡萄球菌菌株的患者特征、耐甲氧西林金黄色葡萄球菌序列类型和生物膜产生情况。
通过临床微生物学实验室监测，确定两家医院住院的所有成年耐甲氧西林金黄色葡萄球菌BSI患者。仅纳入在BSI发作期间至少有一个植入异物的患者。
2018年7月至2022年3月，在423例确诊为耐甲氧西林金黄色葡萄球菌BSI的患者中，118例（28%）有≥1个异物。其中，51例（43%）发生了一种或多种异物感染。在多变量分析中，与异物感染相关的因素包括：去年有耐甲氧西林金黄色葡萄球菌感染史（OR=4.7 [1.4 - 15.5]，p = 0.012）；社区获得性BSI（OR=68.1 [4.2 - 1114.3]，p = 0.003）；手术部位感染作为感染源（OR=11.8 [2 - 70.4]，p = 0.007）；存在不止一个异物（OR=3.4 [1.1 - 10.7]，p = 0.033）；异物植入与感染之间的间隔<18个月（OR=3.3 [1.1 - 10]，p = 0.031）；以及血培养阳性≥48小时（OR=16.7 [4.3 - 65.7]，p<0.001）。最常见的序列类型是ST8（39%），其次是ST5（29%）和ST105（20%），有或没有异物感染的患者之间无显著差异。仅39%的耐甲氧西林金黄色葡萄球菌分离株形成中度/强生物膜。异物感染患者和无异物感染患者之间未观察到显著差异。在多变量分析中，感染产生中度/强生物膜的耐甲氧西林金黄色葡萄球菌分离株的受试者更有可能有去年耐甲氧西林金黄色葡萄球菌感染史（OR=3.41 [1.23 - 9.43]）、异物植入与耐甲氧西林金黄色葡萄球菌BSI之间的间隔<18个月（OR=3.1 [
