Point-of-care universal screening for meticillin-resistant Staphylococcus aureus: a cluster-randomized cross-over trial
Point-of-care universal screening for meticillin-resistant Staphylococcus aureus: a cluster-randomized cross-over trial
复制标题
DOI：
10.1016/j.jhin.2016.08.017
复制
发表时间：
2017-03-01
影响因子：
6.9
通讯作者：
French, G. L.
中科院分区：
文献类型：
--
作者：
Wu, P. J.;Jeyaratnam, D.;French, G. L.
背景资料：耐甲氧西林金黄色葡萄球菌（MRSA）在医疗机构中经常流行，并可能通过人与人之间的传播传播。无症状的MRSA携带者是潜在的、未被怀疑的传播源，其中一些可能通过入院筛查被发现。目的：评估与较慢的基于实验室的方法相比，入院时MRSA的快速护理点筛查（POCS）是否可能与MRSA获得率的降低相关。方法：在伦敦一家三级医院的四个急诊病房进行了一项随机分组交叉试验。将基于聚合酶链反应的POCS筛选与常规培养筛选进行比较。患者在入院和出院时进行筛查，并计算入院时MRSA感染率作为主要结局measure.Results：共纳入10,017例患者，对照组4978例，POCS组5039例，入院时MRSA携带率为1.7%。POCS将中位报告时间从40.4小时缩短至3.7小时（P < 0.001）。对照组和干预组分别有23例（0.46%）和24例（0.48%）患者在入院病房获得MRSA，获得率分别为5.39和4.60/1000天。考虑预定义的混杂因素后，MRSA感染趋势变化的校正发生率比（IRR）为0.961（95%置信区间：0.766-1.206）。结论：与细菌培养筛查相比，POCS能显著提高MRSA检出率，但对MRSA检出率无影响。在感染预防和控制依从性高且MRSA携带率低的情况下，与传统的培养筛查相比，POCS在入院后1至4天内对MRSA感染率没有额外的影响。(C)2016作者出版社：Elsevier Ltd
Background: Meticillin-resistant Staphylococcus aureus (MRSA) is frequently endemic in healthcare settings and may be transmitted by person-to-person spread. Asymptomatic MRSA carriers are potential, unsuspected sources for transmission and some of them may be identified by admission screening.Aim: To assess whether rapid point-of-care screening (POCS) for MRSA at hospital admission may be associated with a reduction in MRSA acquisition rates when compared with slower laboratory-based methods.Methods: A cluster-randomized cross-over trial was conducted in four admission wards of an acute London tertiary care hospital. Polymerase chain reaction-based POCS screening was compared with conventional culture screening. Patients were screened on ward admission and discharge, and the MRSA acquisition rate on the admission wards was calculated as the primary outcome measure.Results: In all, 10,017 patients were included; 4978 in the control arm, 5039 in the POCS arm. The MRSA carriage rate on admission was 1.7%. POCS reduced the median reporting time from 40.4 to 3.7 h (P < 0.001). MRSA was acquired on the admission wards by 23 (0.46%) patients in the control arm and by 24 (0.48%) in the intervention arm, acquisition rates of 5.39 and 4.60 per 1000 days respectively. After taking account of predefined confounding factors, the adjusted incidence rate ratio (IRR) for change in trend for MRSA acquisition was 0.961 (95% confidence interval: 0.766-1.206). The adjusted IRR for step change for MRSA acquisition was 0.98 (0.304-3.162).Conclusion: POCS produces a significantly faster result but has no effect on MRSA acquisition on admission wards compared with culture screening. Where compliance with infection prevention and control is high and MRSA carriage is low, POCS has no additional impact on MRSA acquisition rates over the first one to four days of admission compared with conventional culture screening. (C) 2016 The Authors. Published by Elsevier Ltd