Epidemiology of Community-Onset Oxacillin Resistant Staphylococcus Aureus infection or Conlonization

• Main Authors: Shu-Hua Huang, 黃樹樺
• Other Authors: Hsiu-Hua Pai
• Format: Others
• Language: zh-TW
• Published: 2004
• Online Access: http://ndltd.ncl.edu.tw/handle/25365069150386837046

碩士 === 高雄醫學大學 === 公共衛生學研究所碩士班 === 92 === Oxacillin-resistant Staphylococcus aurues (ORSA) is one of the important nosocomial pathogens .The prevalence of community-onset ORSA (CO-ORSA) in Taiwan has increased markedly in the past 10 years. CO-ORSA patients had no significant predisposing factors which is different from the nosocomial ORSA. A retrospective case-control comparison study of the clinical characteristics, risk factors and antibiotics susceptibility for CO-ORSA compared with CO-OSSA (community-onset oxacillin-susceptible Staphylococcus aurue ) infection or colonization in adult outpatients was performed from January 2003 to October 2003 at Kaoshiung Medical University Hospital. One hundred and fifty eight CO-ORSA and 158 CO-OSSA infected patients were enrolled in this study for comparison and analysis. The results show that the most common site of CO-ORSA infection or colonization was skin and soft tissue (44.3%), following by wound (17.7%) and blood stream (15.2%). The percentage of patients infected with CO-OSSA was similar to the CO-ORSA. The average age of CO-ORSA group were 52.9± 18.6 years, and 39.5% (62/157) of them need walker or were bed-ridden. The average amount of people who living together were 4.8 ±1.5,and 8.3 % of them lived in LCTFs; The average times of visiting OPD and / or ER were 50.6 ±35.9. The frequencies of hospitalization were 1.2 ±1.7 , which had significant difference compared to CO-OSSA group. It shows a significant dose-effect response in the number of admissions or OPD/ER visit in group of CO-ORSA. In comparing with CO-OSSA patients , CO-ORSA patients had higher percentage of malignancy (24.1%), cerebral-vascular accidents (10.1%) and chronic nasal disease ( 7.0%).Use of antibiotics, surgery, foley catheters and nasal-gastric tube in the previous 3 months were commonly seen in patients with CO-ORSA infected which is statistically significant (p< .05). After Logistic regression analysis, the independent risk factors for developing CO-ORSA were residing in LCTF, disabilities, chronic nasal disease , cerebral-vascular accidents, use of antibiotics and previous hospitalization. Most of the isolated CO-ORSA had a low susceptibility against most antibiotics, including co-trimoxazole (62%), chloramphenicol (61%), netilmicin (61%) , gentamicin (59%), amoxicillin/clavulanate (48%), cefazolin (48%), ampicillin/sulbactam (47%) and clindamycin (21%). During the process of medical treatment, CO-ORSA can be carried for 6 months. According to the study, the patient of skin or soft tissue ORSA infection, precautions of infection control should be performed as early as possible to reduce the rate of cross- infection when they admitted again.