Are active microbiological surveillance and subsequent isolation needed to prevent the spread of methicillin-resistant Staphylococcus aureus?
Are active microbiological surveillance and subsequent isolation needed to prevent the spread of methicillin-resistant Staphylococcus aureus?
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DOI：
10.1086/427281
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发表时间：
2005-02-01
影响因子：
11.8
通讯作者：
Weinstein, RA
中科院分区：
文献类型：
--
作者：
Nijssen, S;Bonten, MJM;Weinstein, RA
背景预防控制策略通常结合联合收割机几种干预措施。然而，个别干预措施的相对价值很少确定。我们评估了每日微生物监测的效果（e。例如，在一个实施例中，不报告培养结果或隔离定殖患者）作为对甲氧西林敏感金黄色葡萄球菌（MSSA）和耐甲氧西林金黄色葡萄球菌传播的感染控制措施。金黄色葡萄球菌（MRSA）在医疗重症监护病房（MICU）。MSSA和MRSA患者的定植通过每天采集的鼻拭子培养物进行评估，如果患者接受插管，则通过额外的气管内抽吸物培养物进行评估。脉冲场凝胶电泳用于确定监测培养物中MSSA或MRSA分离株之间的相关性（即，每天获得的鼻拭子样本的培养物）和临床培养物中的那些（即，用于临床目的的任何其它培养物）。通过观察医护人员与患者的相互作用来确定医护人员对感染控制措施的依从性。在10周期间，对158名患者进行了监测培养。55例患者（34.8%）被MSSA定植，9例（5.7%）被MRSA定植。62例患者在入院前进行了定植（53例MSSA，9例MRSA）。两名患者似乎已经获得MSSA在MICU，但基因分型分析的基础上，我们确定这不是交叉收购的结果。MRSA和MSSA分离株的监测培养和基因分型表明，尽管正在引入这些病原体，但MICU患者之间不存在交叉传播。报告培养结果和隔离殖民患者，如一些指南所建议的那样，会错误地暗示这种感染控制政策的成功。
Background. Infection-control strategies usually combine several interventions. The relative value of individual interventions, however, is rarely determined. We assessed the effect of daily microbiological surveillance alone ( e. g., without report of culture results or isolating colonized patients) as an infection-control measure on the spread of methicillin-susceptible Staphylococcus aureus ( MSSA) and methicillin-resistant S. aureus ( MRSA) in a medical intensive care unit ( MICU).Methods. Colonization of patients with MSSA and MRSA was assessed by cultures of nasal swabs obtained daily and, if a patient was intubated, by cultures of additional endotracheal aspirates. Pulsed-field gel electrophoresis was used to determine relatedness between MSSA or MRSA isolates in surveillance cultures (i.e., cultures of nasal swab specimens obtained daily) and those in clinical cultures (i.e., any other culture performed for clinical purposes). Adherence to infection-control measures by health care workers (HCWs) was determined by observations of HCW-patient interaction.Results. During a 10-week period, surveillance cultures were performed for 158 patients. Fifty-five patients (34.8%) were colonized with MSSA, and 9 (5.7%) were colonized with MRSA. Sixty-two patients were colonized before admission to the hospital ( 53 had MSSA, and 9 had MRSA). Two patients appeared to have acquired MSSA in the MICU, but, on the basis of genotyping analysis, we determined that this was not the result of cross-acquisition.Conclusion. Surveillance cultures and genotyping of MRSA and MSSA isolates demonstrated the absence of cross-transmission among patients in the MICU, despite ongoing introduction of these pathogens. Reporting culture results and isolating colonized patients, as suggested by some guidelines, would have falsely suggested the success of such infection-control policies.