Community2acquired methicill in2resistant St a p hyl ococcus a ureus

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1 376 : ; ; ; :R :A : (2005) Community2acquired methicill in2resistant St a p hyl ococcus a ureus W A N G Fu. ( I nstit ute of A ntibiotics, H uashan Hos pit al, S hang hai , Chi na) 40, (MRSA),, [8 ], MRSA, : HA2MRSA [124 ], 1982 MRSA ( 40 ), [324 ], 1 HA2MRSA ; CA2MRSA MRSA ( HA2MRSA) 20, 90, ( ) ( ) MRSA ( CA2MRSA), CA2MRSA, CA2MRSA 1999 CDC 4 (community onset ) MRSA ( CO2MR2 CA2MRSA, 3 SA),, ( ) [5 ], ; CA2MRSA HA2MRSA CA2MRSA CDC : CA2, MRSA : 48 h [6 ] CA2MRSA CA2MRSA CA2MRSA, CA2MRSA :, :,, : 2 CA2MRSA, CA2MRSA 8 [7 ] CA2MRSA, 48 h MRSA,, HA2MRSA ; 1 ; [8 ] CA2MRSA, : MRSA CA2MRSA ; MRSA : MRSA CA2 MRSA % ( ) % ( ) ; MRSA

2 Chin J Infect Chemot her, Dec. 2005, Vol. 5, No %, CA2MRSA 0. 2 % HA2MR2 SA [7 ] CA2MRSA 0. 4 % MRSA 0. 8 % 3 % [9 ] CA2MRSA CA2MRSA 1 % 8 % CA2MRSA 14 [10 ] Nai2 mi MRSA ( PF GE), 12 % CA2MRSA,85 % HA2MRSA ; 75 % CA2MRSA CA2MRSA, PF GE 84 %, 86 % PF GE HA2MRSA, CA2MR2 SA HA2MRSA CA2MRSA [6 ] CA2MRSA, : (, CA2MRSA ),, [11212 ] CA2MRSA,, ( CA2MRSA 23, HA2MRSA 68 ) > 1 1 CA2MR2 SA [ 10 ] CA2MRSA : SCC mec (stap hylococcal cassette chromosome), mec A,, [10,13 ] ; 5 SCC mec, SCC mec ML ST (multilocus sequence type, HA2MRSA, mec A SCC mec SCC mec CA2MRSA MRSA,,,SCC mec, mec A, CA2MRSA MRSA ( 1), SCC mec IV,, CA2MRSA PVL ( Panton2Valentine leucocidin),pvl,,,, [14215 ], CA2MRSA, [6,12 ] CA2MRSA, min ( HA2MRSA min), 1 5 mec Table 1. The five types of the mec gene complex SCC mec type Size ( kb) Features Lacks antibiotic resistance genes Associated wit h multiple drug resistance Associated wit h multiple drug resistance Resistant to 2lactam antibiotics Lacks antibiotic resistance genes other than mec A CA2MRSA MRSA mec A (CNS) mec ( ), mec A, (MR2CNS) CNS mec A, SCC mec, SCC mec CNS ( ), ST ),CA2MRSA HA2MRSA MSSA ( CA2MRSA HA2MRSA ) CA2 MRSA,

3 378 SCC mec, DNA, MSSA SCC mec [6 ] CA2MRSA CA2MRSA : : PCR SCC mec : CA2MR2 SA SCC mec, HA2MRSA SCC mec ( ) PF GE, CA2MRSA,, PF2 GE, ( 2) [10,16 ] MLST, A DNA (Spa A ) MLST SCC mec [1,6,13 ] CA2MRSA ( ),,,,,,, 2 CA2MRSA [10 ] Table 2. Clinical features of community2acquired MRSA infections Location Study period No. of cases in children ( %) 3 Diagnosis Mortality ( %) Chicago : Children s Hospital (100) 82 % skin/ soft tissue, % pneumonia Hawaii : Army hospital (43) 93 % skin/ soft tissue, 0 7 % pneumonia Minnesota : American Indian reservation (?) 89 % skin/ soft tissue 0 Minnesota : multiple laboratories ( > 60) 84 % skin/ soft tissue, 3 % pneumonia 4 % otitis media, % bursitis, 3 % osteomyelitis Alaska : Eskimo village (?) 100 % skin/ soft tissue 0 Texas :Children s hospital (100) 89 % skin/ soft tissue, 3 % pneumonia, 3 % osteomyelitis Minnesota : multiple laboratories facilities (43) 75 % skin/ soft tissue 7 % otitis media, 8 % pneumonia France : multiple cities (57) 79 % skin/ soft tissue, 14 3 ( %) percentage of children below 18 years old. 14 % pneumonia CA2MRSA MSSA,, CA2MRSA, CA2 MRSA, CA2MRSA,, Eady [ 6 ] 4, ( 3)

4 Chin J Infect Chemot her, Dec. 2005, Vol. 5, No CA2MRSA (SCC mec,, ) Table 3. Risk factors of patients with communty2associated infections ( SCC mec + ve, methicillin heteroresistant and non2multiresistant) Risk factor type 1 Risk factor type 2 Risk factor type 3 Risk factor type 4 Previous healthy Patients with primary skin infections (e. g. Et hnic minority group Age : risk decreases as No recent direct or indirect hospital/ furuncles, impetigo, scalded skin syndrome) ; Low socioeconomic age increases care facility exposure Patients with abscess or cellulitis stat us Patients with risk factor for MSSA 1 ; 4 CA2MRSA HA2MRSA ( 4) [8,10,15 ] 4 CA2MRSA HA2MRSA Table 4. Phenotypic expression of SCC mec types, Antibiotics and isolates CA2MRSA (55) mec MIC range (mg/ L) HA2MRSA (30) mec and Daptomycin Clindamycin > 32 Linezolid Erythromycin > 322 > 512 Doxycycline > 512 Oxacillin > 512 Vancomycin TMP2SMZ 0. 06/ / / / 640 Imipenem Cefaclor > 128 Ciprofloxacin > 64 Moxifloxacin CA2MR2 SA, : 100 %, 94 %, 99 %, 75 %, ( TMP2SMZ) 75 %, 84 %,, ; TMP2SMZ CA2MRSA,, CA2MRSA, 10 %,, MRSA, MRSA MRSA, MRSA, MR2 SA [ 17 ], ( ) MRSA, GISA VRSA,, 2 MSSA, MRSA, 2003 FDA, MRSA, CA2MRSA [10,12,16 ] CA2MRSA, MRSA,,, TMP2SMZ CA2MRSA,, ( ), ( CNS ), HA2MRSA, MSSA CA2MRSA

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