METHICILLIN-RESISTANT STAPHYLOCOCCAL COLONIZATION AND INFECTION IN A LONG-TERM CARE FACILITY
METHICILLIN-RESISTANT STAPHYLOCOCCAL COLONIZATION AND INFECTION IN A LONG-TERM CARE FACILITY
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DOI：
10.7326/0003-4819-114-2-1-107
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发表时间：
1991-01-15
影响因子：
39.2
通讯作者：
YU, VL
中科院分区：
文献类型：
--
作者：
MUDER, RR;BRENNEN, C;YU, VL
目的：确定长期护理机构患者中耐甲氧西林金黄色葡萄球菌（MRSA）定植的自然史。我们特别试图确定MRSA定植是否是后续感染的预测。设计：队列研究。设置：长期退伍军人事务医疗中心。患者：共197例患者居住在两个单位，定期监测培养的前鼻孔。主要结果测量：葡萄球菌感染的发展。结果：32例患者为MRSA持续携带者，44例为甲氧西林敏感菌株（MSSA）持续携带者。25%的MRSA携带者有葡萄球菌感染，而MSSA携带者和非携带者分别为4%和4.5%（P < 0.01;相对危险度3.8%; 95%CI，2.0 - 6.4）。MRSA携带者每100天的感染率为15%。使用逻辑回归分析，持续MRSA携带是感染的最重要预测因素（P < 0.001;比值比，3.7）。73%的MRSA感染发生在MRSA携带者中。对7例患者的MRSA分离株进行了分型。定植和感染菌株有相同的噬菌体类型在所有7例患者和相同的模式的质粒EcoRI限制性内切酶片段在5 patients.Conclusions：MRSA的前鼻孔定植预测葡萄球菌感染的发展，在长期护理的患者，大多数感染来自内源性携带的菌株。MRSA定植表明感染的风险显著高于MSSA定植。这些结果为通过旨在消除携带者状态的干预措施减少MRSA感染提供了理论依据。
Objective: To determine the natural history of colonization by methicillin-resistant Staphylococcus aureus (MRSA) among patients in a long-term care facility. We specifically sought to determine if MRSA colonization was predictive of subsequent infection.Design: Cohort study.Setting: Long-term Veterans Affairs Medical Center.Patients: A total of 197 patients residing on two units were followed with regular surveillance cultures of the anterior nares.Main Outcome Measurement: The development of staphylococcal infection.Results: Thirty-two patients were persistent carriers of MRSA and 44 were persistent carriers of methicillin-susceptible strains (MSSA). Twenty-five percent of MRSA carriers had an episode of staphylococcal infection compared with 4% of MSSA carriers and 4.5% of non-carriers (P < 0.01; relative risk 3.8%; 95% CI, 2.0 to 6.4). The rate of development of infection among MRSA carriers was 15% for every 100 days of carriage. Using logistic regression analysis, persistent MRSA carriage was the most significant predictor of infection (P < 0.001; odds ratio, 3.7). Seventy-three percent of all MRSA infections occurred among MRSA carriers. Isolates of MRSA from 7 patients were typed. Colonizing and infecting strains had the same phage type in all 7 patients and the same pattern of plasmid EcoRI restriction endonuclease fragments in 5 patients.Conclusions: Colonization of the anterior nares by MRSA predicts the development of staphylococcal infection in long-term care patients; most infections arise from endogenously carried strains. Colonization by MRSA indicates a significantly greater risk for infection than does colonization by MSSA. The results offer a theoretic rationale for reduction in MRSA infections by interventions aimed at eliminating the carrier state.