Impact of infection control interventions and antibiotic use on hospital MRSA: a multivariate interrupted time-series analysis
Impact of infection control interventions and antibiotic use on hospital MRSA: a multivariate interrupted time-series analysis
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DOI：
10.1016/j.ijantimicag.2007.04.005
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发表时间：
2007-08-01
影响因子：
10.8
通讯作者：
Gould, I. M.
中科院分区：
文献类型：
--
作者：
Mahamat, A.;MacKenzie, F. M.;Gould, I. M.
自1997年以来，苏格兰东北部的医院经历了耐甲氧西林金黄色葡萄球菌（MRSA）的爆发。随后采取了几项感染控制措施来控制MRSA，并对抗生素的使用进行了监测。从1997年1月至2004年12月，非重复MRSA感染的每月百分比（%MRSA）的数据进行了整理，从干预医院（IH）和对照医院（CH）。两家医院都在2002年11月推出了酒精洗手液。此外，环境卫生署在2001年3月推行了一项环境耐药性金黄色葡萄球菌拭子计划，在2001年9月为环境进行氯消毒，在2001年12月进行排出物检查，在2003年11月进行入院检查，并在2004年3月进行环境审核。多变量动态回归分析被用来评估这些干预措施的纵向影响，衡量新的临床病例MRSA。在IH，MRSA %在1998年1月至2001年1月期间增加，然后下降。在CH，MRSA %从1997年1月至2004年12月增加。对于IH和CH，引入酒精手部凝胶分别与%MRSA的绝对下降21%和30%相关。在IH，引入氯消毒和环境擦拭分别与%MRSA立即下降27%和3个月后下降32%相关。出院筛查和环境审计对%MRSA没有显著影响，而入院筛查与4个月后%MRSA下降22%相关。增加大环内酯类药物的使用与增加%MRSA在两家医院，增加喹诺酮类药物的使用与增加%MRSA在CH。实施逐步感染控制措施与减少%MRSA在IH。在两家医院中，引入酒精凝胶用于手部卫生与MRSA %下降相关。抗生素的使用也会影响%MRSA，特别是大环内酯类和喹诺酮类。(c)2007年Elsevier B.V.和国际化疗学会。All rights reserved.
Hospitals in the northeast of Scotland have experienced methicillin-resistant Staphylococcus aureus (MRSA) outbreaks since 1997. Several infection control measures were introduced sequentially to control MRSA, and antibiotic use has been monitored. From January 1997 to December 2004, data on the monthly percentage of non-duplicate MRSA infections (%MRSA) were collated from an intervention hospital (IH) and a control hospital (CH). Both hospitals introduced the Use of alcohol hand gel in November 2002. Furthermore, the IH introduced an environmental MRSA swabbing programme in March 2001, chlorine disinfection of the environment in September 2001, discharge screening in December 2001, admission screening in November 2003 and environmental audits in March 2004. Multivariate dynamic regression analysis was used to evaluate the longitudinal effects of these interventions as measured by new clinical cases of MRSA. At the IH, the %MRSA increased between January 1998 and January 2001 and then decreased. At the CH, the %MRSA increased from January 1997 to December 2004. Introduction of alcohol hand gel was associated with an absolute decrease in %MRSA of 21 % and 30%, respectively, for the IH and CH. At the IH, introduction of chlorine disinfection and environmental swabbing were, respectively, associated with a decrease in %MRSA of 27% immediately and 32% 3 months later. Discharge screening and environmental audit did not significantly affect %MRSA, whereas admission screening was associated with a 22% decrease in %MRSA 4 months later. Increasing macrolide use was associated with increasing %MRSA in both hospitals, and increasing quinolone use was associated with increasing %MRSA in the CH. Implementation of stepwise infection control measures was associated with a decrease in %MRSA in the IH. Introduction of an alcohol gel for hand hygiene was associated with a decrease in %MRSA in both hospitals. Antibiotic use also affects %MRSA, in particular that of macrolides and quinolones. (c) 2007 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.