病人鼻腔中MRSA-USA300流行株的主动监测(有奖翻译）

潮水

Prevalence of USA300 Strain Type of Methicillin‐Resistant Staphylococcus aureus among Patients with Nasal Colonization Identified with Active Surveillance
Infect Control Hosp Epidemiol 2010;31:469–475
Background.USA300 is the most prevalent strain type of community‐acquired methicillin‐resistant Staphylococcus aureus (MRSA), but the proportion of patients colonized with USA300 strains and their risk for infection are largely unknown.

Objective.To determine the prevalence of USA300 strains among MRSA nasal colonizing isolates in our hospital, to identify risks for USA300 nasal colonization, and to determine risks of developing infection for nasally colonized patients.

Methods.Retrospective cohort study of patients found to be nasally colonized with MRSA through active surveillance at a tertiary care hospital from January 2005 through December 2007. MRSA isolates were identified as USA300 or non‐USA300. Risks for colonization and infection were identified with logistic regression.

Results.Among 1,306 MRSA nasal isolates, 307 (24%) were USA300 strains, and this proportion significantly increased over time (17.4% in 2005 and 26.7% in 2007;  ). African American race was an independent risk for USA300 nasal colonization (odds ratio [OR], 1.81 [95% confidence ratio {CI}, 1.38–2.38]). Older age (OR, 0.97 [95% CI, 0.96–0.98]) and female sex (OR, 0.74 [95% CI, 0.56–0.97]) decreased risk. Among nasally colonized patients, 238 (18.2%) developed infection. Increased length of stay (OR, 1.03 [95% CI, 1.01–1.06]) independently increased risk for infection among patients nasally colonized with USA300 MRSA, and female sex decreased risk (OR, 0.48 [95% CI, 0.24–0.95]). Increased length of stay (OR, 1.03 [95% CI, 1.02–1.04]) and treatment in an intensive care unit (OR, 1.64 [95% CI, 1.10–2.44]) independently increased risk for infection among patients nasally colonized with non‐USA300 MRSA, and female sex decreased risk (OR, 0.67 [95% CI, 0.47–0.94]).

Conclusion.The proportion of MRSA nasally colonized patients with USA300 strains significantly increased during the study, and risks included African American race. Strain type had no significant effect on the proportion of patients who developed infection, and risk factors for infection were similar.

许芳霏霏

病人鼻腔中MRSA-USA300流行株的主动监测
医院感染控制流行病学2010; 31:469-475 背景：USA300是社区感染MRSA的最流行的菌株类型，但有USA300菌株定植的病人的比例及病人感染的风险在很大程度上是未知的。
目的：为了确定医院鼻腔定植MRSA-USA300流行株的分离率，以确定USA300鼻腔定植的风险，并确定鼻腔定植患者发生感染的的风险。 方法：从2005年1月至2007年12月对一个三级保健医院被发现有鼻腔MRSA定植的患者主动监测的回顾性队列研究，进行MRSA的分离以确定USA300或非USA300，利用数学回归统计方法确定定植和感染的风险。
结果：从1,306株分离的鼻腔定植MRSA中，307株（24％）是USA300流行菌株，而且这个比例随着时间显著上升（2005年17.4％和2007年26.7％）。对于非洲裔美国人种就有鼻腔定植USA300的风险（OR 1.81 ，95％CI 1.38-2.38）。年龄较大(OR, 0.97 [95% CI, 0.96–0.98])和女性(OR, 0.74 [95% CI, 0.56–0.97])风险降低。在鼻腔定殖患者中，238株（18.2％）出现感染。增加住院时间(OR, 1.03 [95% CI, 1.01–1.06])可自形增加在鼻腔定植MRSA-USA300菌株的患者中感染的风险而女性可降低风险。增加住院时间(OR, 1.03 [95% CI, 1.02–1.04])和在重症监护病房治疗(OR, 1.64 [95% CI, 1.10–2.44])同样可自形增加在鼻腔定植非MRSA-USA300菌株的患者中感染的风险而女性可降低风险(OR, 0.67 [95% CI, 0.47–0.94])。
结论：鼻腔定植MRSA-USA300菌株患者的比例及非洲裔美国人种的风险在研究中显著的提高，菌株的种类对发生感染的患者比例没有明显的影响，而且感染的危险因素是相似的。
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