Evaluation of rapid screening and pre-emptive contact isolation for detecting and controlling methicillin-resistant Staphylococcus aureus in critical care: an interventional cohort study.
Evaluation of rapid screening and pre-emptive contact isolation for detecting and controlling methicillin-resistant Staphylococcus aureus in critical care: an interventional cohort study.
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DOI：
10.1186/cc3982
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发表时间：
2006-02
期刊：
影响因子：
--
通讯作者：
Pittet D
中科院分区：
文献类型：
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作者：
Harbarth S;Masuet-Aumatell C;Schrenzel J;Francois P;Akakpo C;Renzi G;Pugin J;Ricou B;Pittet D
快速诊断检测可以在重症监护室（ICU）入院时早期识别以前未知的耐甲氧西林金黄色葡萄球菌（MRSA）携带者。本研究的目的是双重的：第一，评估一种新的分子MRSA筛查测试是否可以大大减少ICU入院和MRSA携带者识别之间的时间;第二，检查快速检测和先发制人的接触隔离对MRSA感染的综合影响。自2003年11月以来，在两个成人ICU住院超过24小时的患者在入院时使用快速多重免疫捕获偶联PCR（qMRSA）进行系统筛查。计算了5个月干预期（2003年11月至2004年3月）从入院到通知检查结果的中位时间间隔，并通过非参数检验与历史对照期（2003年4月至2003年10月）进行了比较。ICU获得性MRSA感染率在延长的监测期（2003年1月至2005年8月）内测定，并采用泊松回归方法进行分析。在干预阶段，97%（450/462）的外科ICU患者和80%（470/591）的内科ICU患者接受了筛查。入院筛查确定MRSA的患病率为6.7%（71/1053）。如果没有入院筛查，55名以前未知的MRSA携带者将在两个ICU中被遗漏。从ICU入院到通知检查结果的中位时间在外科ICU中从87小时降至21小时（P < 0.001），在内科ICU中从106小时降至23小时（P < 0.001）。在外科ICU中，通过使用qMRSA测试，245名MRSA阴性患者节省了1，227个先发制人的隔离日。在调整定植压力后，系统的入院筛查和先发制人的隔离政策与减少内科ICU获得性MRSA感染相关（相对风险0.3，95%置信区间0.1-0.7），但在外科ICU中没有效果（相对风险1.0，95%置信区间0.6-1.7）。qMRSA测试将通知的中位时间从4天缩短到1天，并有助于快速识别以前未知的MRSA携带者。一项将快速筛查试验与MRSA患者的先发制人隔离和聚集联系起来的策略大大减少了MRSA在内科ICU中的交叉感染，但在外科ICU中没有。
Rapid diagnostic tests may allow early identification of previously unknown methicillin-resistant Staphylococcus aureus (MRSA) carriers at intensive care unit (ICU) admission. The aim of this study was twofold: first, to assess whether a new molecular MRSA screening test can substantially decrease the time between ICU admission and identification of MRSA carriers; and, second, to examine the combined effect of rapid testing and pre-emptive contact isolation on MRSA infections. Since November 2003, patients admitted for longer than 24 hours to two adult ICUs were screened systematically on admission using quick, multiplex immunocapture-coupled PCR (qMRSA). Median time intervals from admission to notification of test results were calculated for a five-month intervention phase (November 2003–March 2004) and compared with a historical control period (April 2003–October 2003) by nonparametric tests. ICU-acquired MRSA infection rates were determined for an extended surveillance period (January 2003 through August 2005) and analyzed by Poisson regression methods. During the intervention phase, 97% (450/462) of patients admitted to the surgical ICU and 80% (470/591) of patients admitted to the medical ICU were screened. On-admission screening identified the prevalence of MRSA to be 6.7% (71/1053). Without admission screening, 55 previously unknown MRSA carriers would have been missed in both ICUs. Median time from ICU admission to notification of test results decreased from 87 to 21 hours in the surgical ICU (P < 0.001) and from 106 to 23 hours in the medical ICU (P < 0.001). In the surgical ICU, 1,227 pre-emptive isolation days for 245 MRSA-negative patients were saved by using the qMRSA test. After adjusting for colonization pressure, the systematic on-admission screening and pre-emptive isolation policy was associated with a reduction in medical ICU acquired MRSA infections (relative risk 0.3, 95% confidence interval 0.1–0.7) but had no effect in the surgical ICU (relative risk 1.0, 95% confidence interval 0.6–1.7). The qMRSA test decreased median time to notification from four days to one day and helped to identify previously unknown MRSA carriers rapidly. A strategy linking the rapid screening test to pre-emptive isolation and cohorting of MRSA patients substantially reduced MRSA cross-infections in the medical but not in the surgical ICU.