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zoom RSS MRSAは英国より米国でより広まっている/多剤耐性菌

<<   作成日時 : 2010/10/25 20:25   >>

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 新たな政府のデータによれば、MRSAメチシリン耐性黄色ブドウ球菌は英国より米国でより広まっている。院内感染では同等だが、市中感染では6倍以上に見られる。
 2005年に米国では約95,000人が重症感染をおこし、18,500人が死亡している。新たな政府統計によれば、年間のMRSA血流感染者は英国で10万人あたり11人であるのに米国では約29人にのぼる。さらに病院外で獲得したと推定された感染で見ると、英国では3.5人に対し米国では22人にもなる。
 病院外で発症したMRSAの3/4以上の米国人は近い時期に医療施設に通ったことがあり、透析患者が英国の2倍で糖尿病が多く中心静脈ラインが入っている人が多い。こうした人は一般人より100倍もMRSA感染率が高いと2007年にCDCが報告した。
 
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MRSA superbug much more common in U.S. than UK
http://www.reuters.com/article/idUSTRE69J4Z620101020
By Frederik Joelving

NEW YORK | Wed Oct 20, 2010 2:18pm EDT

NEW YORK (Reuters Health) - The antibiotic-mocking MRSA bacteria seem to be thriving better in the US than in the UK, according to new government data.

They show Americans are more than six times as likely as Britons to contract the superbug in the community, although rates of hospital infections are about the same.

"This is the first time we compared rates of MRSA bloodstream infections between US and England," said Dr. Fernanda Lessa, of the Centers for Disease Control and Prevention in Atlanta. "So, the findings are new to us."

That's despite the fact that MRSA -- or methicillin-resistant Staphylococcus aureus -- was first discovered in the UK and didn't make it across the Atlantic until several years later.

It is estimated that, in 2005, it caused severe infections in nearly 95,000 Americans, killing more than 18,500 of them.

According to the new government statistics, published in the journal Clinical Infectious Diseases, about 29 per 100,000 people in the US contract a MRSA bloodstream infection every year, compared to 11 Britons.

And when looking only at infections presumed to be acquired outside of hospitals, the difference was even bigger: 22 cases per 100,000 in the US and 3.5 in the UK.

"It underlines once again that MRSA is a problem that we need to take more seriously," said journalist Maryn McKenna, who published a book, SUPERBUG, about the bug earlier this year.

The question is, why the big difference?

The study tapped into data from the US Centers for Disease Control and Prevention and the UK Health Protection Agency, and differences between the two surveillance systems could be involved.

But other factors might be at play, too, CDC's Lessa told Reuters Health by e-mail.

For instance, more than three-quarters of Americans with community-onset MRSA had been in recent contact with the healthcare system. Infected Americans were twice as likely as Britons to have been on dialysis, and they more commonly had diabetes or had had a central intravenous line inserted by a health provider.

This hints differences in both medical care and patient type between the two countries are important, the researchers say. More patients are on dialysis for renal failure in the US than in the UK, and the CDC reported in 2007 that MRSA infections were 100 times more common in such patients than in the general population.

McKenna said it was unclear where the bacteria that attack dialysis patients come from.

"We don't know whether they have a hospital strain from a healthcare institution or if they are carrying a community strain that only enters the body when the skin is broken," she told Reuters Health.

People can carry MRSA on their skin or nostrils without getting sick. But when their skin is pierced by a health provider inserting an IV line, the bacteria gain easy access to the blood. Or they may jump to other patients with compromised immune systems.

McKenna said the US had been lagging behind European countries in terms of infection control.

The Netherlands, for instance, has long been screening people for MRSA before admitting them to hospitals. If they carry the bug, they are quarantined so they won't infect others.

While some hospitals in the US have recently implemented such a system, too, they are few and far between, said McKenna.

Still, over the past decade US hospitals have introduced several measures aimed at preventing the spread of infectious disease, such as requiring staff to wash their hands with soap before inserting a catheter into a patient.

And it's possible they are paying off, according to a CDC report earlier this year that showed hospital MRSA infections had dropped since 2005 (see Reuters Health story of Aug 11).

"Great strides have been made in reducing rates of MRSA bloodstream infection in United States hospitals," said Lessa, "and we need to expand this success."

SOURCE: link.reuters.com/duk49p Clinical Infectious Diseases, October 15, 2010.

------------------------------------------------------
Clinical Infectious Diseases 2010;51:925--928
(c) 2010 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2010/5108-0008$15.00
DOI: 10.1086/656414

画像BRIEF REPORT
Comparison of Incidence of Bloodstream Infection with Methicillin‐Resistant Staphylococcus aureus between England and United States, 2006--2007

Fernanda C. Lessa,1 Yi Mu,1 John Davies,2 Miranda Murray,2 Mark Lillie,2
Andrew Pearson,2 and Scott K. Fridkin,1 for the Emerging Infections Program/Active Bacterial Core surveillance MRSA investigators and the

Health Protection Agency team

1Division of Healthcare Quality Promotion, National Center for Preparedness, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; 2Health Protection Agency, London, England, United Kingdom

We compared incidence of methicillin‐resistant Staphylococcus aureus (MRSA) bloodstream infection (BSI) in the United States and England by using population‐based surveillance. The incidence of community‐onset MRSA BSI was 6.3‐fold higher in the United States than in England, whereas the incidence of hospital‐onset MRSA BSI was similar between the 2 countries.


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