Background

Multiple factors affect incident infection rates (IIR) for Pseudomonas aeruginosa (PA) and methicillin resistant Staphylococcus aureus (MRSA) at CF care centers. We assessed changes in IIR across CF centers temporally associated with the 2013 Infection/Prevention & Control guidelines controlling for center-specific factors.

Methods

Using the CF Foundation Patient Registry we defined and measured changes in IIR between 2010-2012 and 2014-2016. Data were compared to non-CF rates of MRSA and resistant PA in geographically similar regions. Characteristics of each CF center (n centers: Adult 54 in 2010 to 82 in 2016. Pediatric ∼106) and their respective population were evaluated for associations with IIR and with changes in IIR between the study periods.

Results

Across the years 35613 patients were included. Incident-infection rates for PA (mean 19.2±0.04% Pediatric, 21.2±0.07% Adult centers) were higher than for MRSA (mean 9.4±0.03% Pediatric, 7.8±0.03% Adult). The IIR decreased for MRSA (-1.54±0.54%, p<0.001) and PA (-4.77±0.63%, p<0.001) at Pediatric but only for PA (-3.20±1.31, p=0.02) at Adult centers. Except for Adult CF, MRSA rates (CF and non-CF) were highest in the South. In 2014-2016, private insurance and a higher proportion of LatinX patients at a center were associated with lower MRSA IIR while larger center size, higher proportion of LatinX, and lower mean center-wide lung function were associated with higher PA IIR. Higher IIR in 2010-2012, were predictive of a more pronounced decrease in IIR in 2014-2016 for MRSA and PA (p<0.001). Different factors indicative of lower social status (smoking, insurance, education) in 2010-2012 predicted decreases in MRSA or PA IIR.

Conclusion

Comparisons of IIR across U.S. CF centers should consider location, ethnic background and socio-economic variables of a center's population.

中文翻译：

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2010-2016 年美国囊性纤维化中心感染率的纵向变化和区域变化

背景

多种因素影响CF 护理中心的铜绿假单胞菌(PA) 和耐甲氧西林金黄色葡萄球菌(MRSA) 的事件感染率 (IIR) 。我们评估了与 2013 年感染/预防和控制指南控制中心特定因素相关的 CF 中心的 IIR 变化。

方法

使用 CF 基金会患者登记处，我们定义并测量了 2010-2012 年和 2014-2016 年间 IIR 的变化。将数据与地理相似地区的 MRSA 和耐药 PA 的非 CF 发生率进行比较。每个 CF 中心（n 个中心：2010 年的 54 名成人至 2016 年的 82 名。儿科~106 名）及其各自人群的特征与 IIR 和研究期间 IIR 变化的关联进行了评估。

结果

多年来，共纳入 35613 名患者。PA 的事件感染率（平均 19.2±0.04% 儿科，21.2±0.07% 成人中心）高于 MRSA（平均 9.4±0.03% 儿科，7.8±0.03% 成人）。儿科 MRSA（-1.54±0.54%，p<0.001）和 PA（-4.77±0.63%，p<0.001）的 IIR 下降，但仅成人中心的 PA（-3.20±1.31，p=0.02）。除成人 CF 外，南方的 MRSA 率（CF 和非 CF）最高。在 2014-2016 年，私人保险和较高比例的 LatinX 患者在中心与较低的 MRSA IIR 相关，而较大的中心规模、较高的 LatinX 比例和较低的平均全中心肺功能与较高的 PA IIR 相关。2010-2012 年更高的 IIR 预示着 2014-2016 年 MRSA 和 PA 的 IIR 下降更明显（p<0.001）。

结论

美国 CF 中心的 IIR 比较应考虑中心人口的位置、种族背景和社会经济变量。