Résumé
Staphylococcus aureus résistant à la méticilline (SARM) est un pathogène majeur, responsable d’un nombre important d’infections chez les patients en réanimation. Les infections sévères liées au SARM sont associées à une augmentation de la mortalité, en comparaison aux infections liées aux souches sensibles à la méticilline. Cependant, après ajustement pour les facteurs confondants, la mortalité est comparable entre les infections à SARM et à S. aureus sensible à la méticilline. La prévalence des SARM a considérablement diminué en France ces dernières années, grâce en partie aux mesures préventives appliquées notamment dans les services de réanimation. Les souches de S. aureus résistantes ou intermédiaires à la vancomycine y sont encore rares. Le SARM communautaire, dont l’incidence est également faible en France, est responsable d’une mortalité élevée en raison d’une virulence accrue en comparaison aux souches associées aux soins. Des caractéristiques génomiques permettent de différencier les souches de SARM communautaires de celles associées aux soins. L’objectif de cette revue est de faire une mise au point sur les données épidémiologiques récentes concernant le SARM et de discuter les différentes mesures préventives proposées pour limiter la diffusion de cette bactérie multirésistante.
Abstract
Methicillin resistant Staphylococcus aureus (MRSA) is responsible for a large number of infections in the intensive care unit (ICU). Severe infections related to MRSA are associated with a high rate of mortality and morbidity. However, after adjustment for confounding factors, mortality is similar in patients with infections related to MRSA and those with infections related to methicillinsensitive S. aureus. The prevalence of MRSA has dramatically decreased in France, which is due to the preventive measures used in ICUs and hospitals. Strains of MRSA that are resistant or intermediate to vancomycin are rare in France. Community-acquired MRSA, which are also rare in France, are responsible for increased mortality because of their higher virulence compared to healthcare-associated strains. Genomic characteristics allow differentiating community-acquired from healthcare-associated MRSA strains. The objective of this review is to provide recent epidemiologic data on MRSA, and to discuss recent findings on preventive measures aiming to reduce the spread of MRSA.
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Kouatchet, A., Eveillard, M. Staphylococcus aureus résistant à la méticilline en réanimation. Réanimation 21, 493–505 (2012). https://doi.org/10.1007/s13546-012-0497-2
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DOI: https://doi.org/10.1007/s13546-012-0497-2
Mots clés
- Staphylococcus aureus méticilline résistant
- SARM
- Unité de soins intensifs
- Épidémiologie
- Facteur de risque
- Prévention