背景:以前的出版物指出了社区获得性耐甲氧西林金黄色葡萄球菌(CA-MRSA)的新问题,特别是皮肤和软组织感染(STTI),在加拿大的土著社区。这项分析的目的是探索社区环境中CA-MRSA引起的SSTIs的患病率和抗菌药物使用模式。
方法:作为环境扫描的一部分,进行了回顾性图表审查,以评估包括艾伯塔省在内的加拿大五个省的12个原住民社区的抗生素处方。萨斯喀彻温省,曼尼托巴省,安大略省,魁北克。从护理站随机选择图表,并将在过去12个月内接受护理且≥18年的患者纳入审查。数据是从9月到12月收集的,2013年关于抗生素处方,包括SSTI,临床症状,诊断信息,包括CA-MRSA感染的存在,和治疗。
结果:共回顾了372张图表,60来自艾伯塔省,70来自萨斯喀彻温省,120来自马尼托巴省,100来自安大略省,22来自魁北克在372名患者中,224名(60.2%)患者在过去12个月内至少有一次抗生素处方,总共有569份处方。SSTI的患病率估计为36.8%(在372个图表中,有137例SSTI)。在137例SSTI中,34例(24.8%)为化脓性感染,55例(40.2%)是由于CA-MRSA。
结论:这项研究发现,在加拿大偏远和孤立的土著社区中,由于CA-MRSA,抗生素使用和SSTI的患病率很高。这一人群目前很难达到,在标准监测系统中代表性不足,随机回顾性图表审查可以提供监测疾病负担的补充方法,治疗和预防。
BACKGROUND: Previous publications indicated an emerging issue with community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA), particularly skin and soft tissue infections (SSTIs), in Indigenous communities in Canada. The objectives of this analysis were to explore the prevalence of SSTIs due to CA-MRSA and patterns of antimicrobial use in the community setting.
METHODS: A retrospective chart
review was conducted as part of an environmental scan to assess antibiotic prescriptions in 12 First Nations communities across five provinces in Canada including Alberta, Saskatchewan, Manitoba, Ontario, and Québec. Charts were randomly selected from nursing stations and patients who had accessed care in the previous 12 months and were ≥ 18 years were included in the
review. Data was collected from September to December, 2013 on antibiotic prescriptions, including SSTIs, clinical symptoms, diagnostic information including presence of CA-MRSA infection, and treatment.
RESULTS: A total of 372 charts were reviewed, 60 from Alberta, 70 from Saskatchewan, 120 from Manitoba, 100 from Ontario, and 22 from Québec. Among 372 patients, 224 (60.2%) patients had at least one antibiotic prescription in the previous 12 months and 569 prescriptions were written in total. The prevalence of SSTIs was estimated at 36.8% (137 cases of SSTIs in 372 charts reviewed). In 137 cases of SSTIs, 34 (24.8%) were purulent infections, and 55 (40.2%) were due to CA-MRSA.
CONCLUSIONS: This study has identified a high prevalence of antibiotic use and SSTIs due to CA-MRSA in remote and isolated Indigenous communities across Canada. This population is currently hard to reach and under-represented in standard surveillance system and randomized retrospective chart reviews can offer complimentary methodology for monitoring disease burden, treatment and prevention.