Methicillin-resistant staphylococcus aureus disease in three communities

被引:1120
作者
Fridkin, SK
Hageman, JC
Morrison, M
Sanza, LT
Como-Sabetti, K
Jernigan, JA
Harriman, K
Harrison, LH
Lynfield, R
Farley, MM
机构
[1] Ctr Dis Control & Prevent, Div Bacterial & Mycot Dis, Natl Ctr Infect Dis, Atlanta, GA USA
[2] Ctr Dis Control & Prevent, Div Healthcare Qual Promot, Natl Ctr Infect Dis, Atlanta, GA USA
[3] Emory Univ, Sch Med, Atlanta, GA USA
[4] Vet Affairs Med Ctr, Atlanta, GA 30033 USA
[5] Johns Hopkins Univ, Bloomberg Sch Publ Hlth, Baltimore, MD USA
[6] Minnesota Dept Hlth, Minneapolis, MN USA
关键词
D O I
10.1056/NEJMoa043252
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) infection has emerged in patients who do not have the established risk factors. The national burden and clinical effect of this novel presentation of MRSA disease are unclear. METHODS: We evaluated MRSA infections in patients identified from population-based surveillance in Baltimore and Atlanta and from hospital-laboratory-based sentinel surveillance of 12 hospitals in Minnesota. Information was obtained by interviewing patients and by reviewing their medical records. Infections were classified as community-acquired MRSA disease if no established risk factors were identified. RESULTS: From 2001 through 2002, 1647 cases of community-acquired MRSA infection were reported, representing between 8 and 20 percent of all MRSA isolates. The annual disease incidence varied according to site (25.7 cases per 100,000 population in Atlanta vs. 18.0 per 100,000 in Baltimore) and was significantly higher among persons less than two years old than among those who were two years of age or older (relative risk, 1.51; 95 percent confidence interval, 1.19 to 1.92) and among blacks than among whites in Atlanta (age-adjusted relative risk, 2.74; 95 percent confidence interval, 2.44 to 3.07). Six percent of cases were invasive, and 77 percent involved skin and soft tissue. The infecting strain of MRSA was often (73 percent) resistant to prescribed antimicrobial agents. Among patients with skin or soft-tissue infections, therapy to which the infecting strain was resistant did not appear to be associated with adverse patient-reported outcomes. Overall, 23 percent of patients were hospitalized for the MRSA infection. CONCLUSIONS: Community-associated MRSA infections are now a common and serious problem. These infections usually involve the skin, especially among children, and hospitalization is common.
引用
收藏
页码:1436 / 1444
页数:9
相关论文
共 38 条
  • [1] Geographic, demographic, and seasonal differences in penicillin-resistant Streptococcus pneumoniae in Baltimore
    Albanese, BA
    Roche, JC
    Pass, M
    Whitney, CG
    McEllistrem, MC
    Harrison, LH
    [J]. CLINICAL INFECTIOUS DISEASES, 2002, 34 (01) : 15 - 21
  • [2] [Anonymous], 1999, JAMA, V282, P1123
  • [3] Staphylococcus aureus:: A well-armed pathogen
    Archer, GL
    [J]. CLINICAL INFECTIOUS DISEASES, 1998, 26 (05) : 1179 - 1181
  • [4] An outbreak of community-onset methicillin-resistant Staphylococcus aureus skin infections in southwestern Alaska
    Baggett, HC
    Hennessy, TW
    Leman, R
    Hamlin, C
    Bruden, D
    Reasonover, A
    Martinez, P
    Butler, JC
    [J]. INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY, 2003, 24 (06) : 397 - 402
  • [5] METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS AT BOSTON CITY HOSPITAL - BACTERIOLOGIC AND EPIDEMIOLOGIC OBSERVATIONS
    BARRETT, FF
    MCGEHEE, RF
    FINLAND, M
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 1968, 279 (09) : 441 - &
  • [6] METHICILLIN-RESISTANT STAPHYLOCOCCUS-AUREUS
    BRUMFITT, W
    HAMILTONMILLER, J
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 1989, 320 (18) : 1188 - 1196
  • [7] Centers for Disease Control and Prevention (CDC), 2001, MMWR Morb Mortal Wkly Rep, V50, P919
  • [8] Centers for Disease Control and Prevention (CDC), 2003, MMWR Morb Mortal Wkly Rep, V52, P88
  • [9] The changing epidemiology of Staphylococcus aureus?
    Chambers, HF
    [J]. EMERGING INFECTIOUS DISEASES, 2001, 7 (02) : 178 - 182
  • [10] Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia:: A meta-analysis
    Cosgrove, SE
    Sakoulas, G
    Perencevich, EN
    Schwaber, MJ
    Karchmer, AW
    Carmeli, Y
    [J]. CLINICAL INFECTIOUS DISEASES, 2003, 36 (01) : 53 - 59