Role of decolonization in a comprehensive strategy to reduce methicillin-resistant Staphylococcus aureus infections in the neonatal intensive care unit: an observational cohort study.
Role of decolonization in a comprehensive strategy to reduce methicillin-resistant Staphylococcus aureus infections in the neonatal intensive care unit: an observational cohort study.
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DOI：
10.1086/652449
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发表时间：
2010-05
影响因子：
4.5
通讯作者：
Perl TM
中科院分区：
文献类型：
--
作者：
Milstone AM;Budd A;Shepard JW;Ross T;Aucott S;Carroll KC;Perl TM
金黄色葡萄球菌是住院新生儿感染的常见原因。耐甲氧西林金黄色葡萄球菌（MRSA）菌株的出现使这些感染的管理变得复杂。在美国，从1995年到2004年，新生儿重症监护病房（NICUs）的MRSA感染发生率大幅上升。在新生儿重症监护室管理MRSA感染的策略包括手卫生、聚集和隔离患者、进行定期监测培养和筛查医护人员。3 2007年4月，在约翰霍普金斯医院42个床位的IV级新生儿重症监护室发生了一系列MRSA感染，医院流行病学和感染控制部启动了一项全面的感染预防和控制策略。该项目包括对从医院外转来的儿童进行入院监测培养，对所有患者进行每周培养，聚集并隔离mrsa定植的患者，加强手卫生依从性，清洁环境表面，并实施严格的接触预防措施。2007年6月，建议对有mrsa定植的婴儿去菌落（即，对所有新生儿使用鼻用莫匹罗星，对大于36孕周或大于4实足年龄的婴儿使用局部氯己定浴）。2007年7月，对保健工作者进行了筛查，使携带者非殖民化。我们的目的是测量随时间推移MRSA感染的发生率，并评估MRSA去殖民化对预防院内MRSA感染的贡献。我们对2002年1月1日至2009年6月30日期间在NICU进行的任何培养中MRSA或甲氧西林敏感金黄色葡萄球菌（MSSA）阳性的患者进行回顾性鉴定。与医疗保健相关的MRSA和MSSA感染符合国家医疗安全网络制定的标准。4 MRSA和MSSA感染的发病率以每10,000患者日感染数计算，并使用线性样条项的泊松回归比较干预前后的发病率。记录2007年6月1日后MRSA定殖患者的特征，包括MRSA感染的发生情况。比较采用Fisher精确检验和Wilcoxon秩和检验，双尾P值小于。使用Stata， 10.0版本（StataCorp）。机构审查委员会批准了我们的研究。
Staphylococcus aureus is a common cause of infection among hospitalized neonates. The management of these infections has become complicated by the emergence of strains of methicillin-resistant S. aureus (MRSA). 1 In the United States, the incidence of MRSA infection in neonatal intensive care units (NICUs) increased substantially from 1995 to 2004. 2 Strategies to manage MRSA infections in the NICU include hand hygiene, cohorting and isolating patients, performing periodic surveillance cultures, and screening healthcare workers. 3 In response to a cluster of MRSA infections in the 42-bed, level IV NICU at The Johns Hopkins Hospital in April 2007, the Department of Hospital Epidemiology and Infection Control initiated a comprehensive infection prevention and control strategy. The program included performing admission surveillance cultures for children transferred from outside hospitals and weekly cultures for all patients, cohorting and isolating MRSA-colonized patients, and reinforcing hand hygiene adherence, cleaning environmental surfaces, and implementing strict contact precautions. In June 2007, decolonization (ie, use of intranasal mupirocin in all neonates and use of topical chlorhexidine baths for infants greater than 36 weeks gestational age or greater than 4 weeks chronological age) was recommended for MRSA-colonized infants. In July 2007, healthcare workers were screened and carriers decolonized. Our objectives were to measure the incidence of MRSA infection over time and to assess the contribution of MRSA decolonization in preventing nosocomial MRSA infections.We retrospectively identified patients in the NICU who were positive for MRSA or methicillin-susceptible Staphylococcus aureus (MSSA) on any culture performed from January 1, 2002, through June 30, 2009. Healthcare-associated MRSA and MSSA infections met the criteria established by the National Healthcare Safety Network. 4 Incidence rates for MRSA and MSSA infections were calculated as number of infections per 10,000 patient-days, and rates before and after the intervention were compared by using Poisson regression with a linear spline term. The characteristics of patients colonized with MRSA after June 1, 2007, including occurrence of MRSA infection, were recorded. Comparisons were made by use of the Fisher exact test and the Wilcoxon rank sum test with a 2-tailed P value of less than. 05, by using Stata, version 10.0 (StataCorp). The institutional review board approved our study.
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