Methicillin-resistant Staphylococcus aureus (MRSA) nares colonization at hospital admission and its effect on subsequent MRSA infection
Methicillin-resistant Staphylococcus aureus (MRSA) nares colonization at hospital admission and its effect on subsequent MRSA infection
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DOI：
10.1086/422997
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发表时间：
2004-09-15
影响因子：
11.8
通讯作者：
Hospenthal, DR
中科院分区：
文献类型：
--
作者：
Davis, KA;Stewart, JJ;Hospenthal, DR
背景耐甲氧西林金黄色葡萄球菌（MRSA）的无症状定植已被描述为随后MRSA感染的风险因素。MRSA是一种重要的医院内病原体，但目前已报告在没有典型危险因素的患者中获得。本研究旨在评估无症状的鼻孔MRSA定植对后续MRSA感染发展的影响。MRSA感染的发生率在有和没有MRSA或甲氧西林敏感的S。金黄色葡萄球菌（MSSA）的定植在入院时和那些谁开发的定植在住院期间。对5家代表性医院的患者进行了前瞻性评价。在入院时和住院期间采集鼻孔样本进行培养。监测实验室培养结果，以确定所有MRSA感染发生在研究期间和1年后。在758例入院时进行鼻孔样本培养的患者中，3.4%的患者定植有MRSA，21%的患者定植有MSSA。入院时MRSA定植的患者和住院期间获得MRSA定植的患者中，分别有19%和25%发生MRSA感染，相比之下，入院时MSSA定植和未定植的患者分别为1.5%和2.0%（P <0.01）。与入院时MSSA定植（相对风险[RR]，13; 95%置信区间[CI]，2.7 - 64）或无葡萄球菌定植（RR，9.5; 95% CI，3.6 - 25）相比，入院时MRSA定植增加了随后MRSA感染的风险。与未感染相比，感染耐甲氧西林金黄色葡萄球菌（MRSA）也会增加随后感染耐甲氧西林金黄色葡萄球菌（MRSA）的风险（RR，12; 95%CI，4.0 - 38）。结论。MRSA在鼻孔的定植，无论是在入院时存在还是在住院期间获得，都会增加MRSA感染的风险。在入院时识别MRSA定植可以针对高危人群，这些人群可能受益于干预措施，以降低随后MRSA感染的风险。
Background. Asymptomatic colonization with methicillin-resistant Staphylococcus aureus ( MRSA) has been described as a risk factor for subsequent MRSA infection. MRSA is an important nosocomial pathogen but has currently been reported in patients without typical risk factors for nosocomial acquisition. This study was designed to evaluate the impact of asymptomatic nares MRSA colonization on the development of subsequent MRSA infection. The incidence of MRSA infection was examined in patients with and patients without MRSA or methicillin-susceptible S. aureus (MSSA) colonization at admission to the hospital and in those who developed colonization during hospitalization.Methods. Patients admitted to 5 representative hospital units were prospectively evaluated. Nares samples were obtained for culture at admission and during hospitalization. Laboratory culture results were monitored to identify all MRSA infections that occurred during the study period and 1 year thereafter.Results. Of the 758 patients who had cultures of nares samples performed at admission, 3.4% were colonized with MRSA, and 21% were colonized with MSSA. A total of 19% of patients with MRSA colonization at admission and 25% who acquired MRSA colonization during hospitalization developed infection with MRSA, compared with 1.5% and 2.0% of patients colonized with MSSA (P < .01) and uncolonized (P < .01), respectively, at admission. MRSA colonization at admission increased the risk of subsequent MRSA infection, compared with MSSA colonization (relative risk [RR], 13; 95% confidence interval [CI], 2.7 - 64) or no staphylococcal colonization ( RR, 9.5; 95% CI, 3.6 - 25) at admission. Acquisition of MRSA colonization also increased the risk for subsequent MRSA infection, compared with no acquisition (RR, 12; 95% CI, 4.0 - 38).Conclusion. MRSA colonization of nares, either present at admission to the hospital or acquired during hospitalization, increases the risk for MRSA infection. Identifying MRSA colonization at admission could target a high-risk population that may benefit from interventions to decrease the risk for subsequent MRSA infection.