Methicillin-resistant Staphylococcus aureus infection or colonization present at hospital admission:: Multivariable risk factor screening to increase efficiency of surveillance culturing
Methicillin-resistant Staphylococcus aureus infection or colonization present at hospital admission:: Multivariable risk factor screening to increase efficiency of surveillance culturing
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DOI：
10.1128/jcm.00315-07
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发表时间：
2007-09-01
影响因子：
9.4
通讯作者：
Haley, Robert W.
中科院分区：
文献类型：
--
作者：
Haley, Clinton C.;Mittal, Deepa;Haley, Robert W.
识别入院时存在的耐甲氧西林金黄色葡萄球菌（MRSA）定植或感染对于减少随后的院内传播非常重要，但最有效的监测方法仍有待确定。在7周的时间里，我们对所有在我们社区医院普通内科就诊和出院的患者进行了鼻前监测培养，并对患者完成了MRSA危险因素的问卷调查。在401例患者中，41例（10.2%）在入院时患有MRSA。在分析的48项风险指标中，10项与入院MRSA显著相关，其中7项在逐步logistic回归分析中独立相关。因子分析确定了8个潜在变量，这些变量包含了48项风险措施中的大部分预测信息。包括潜在变量在内的重复logistic回归分析揭示了入院MRSA的三个独立风险指标：养老院住宿（相对风险[RR]， 6.18； 95%置信区间[95% CI]， 3.56 ~ 10.72; P < 0.0001）、既往MRSA感染（RR, 3.97; 95% CI, 1.94 ~ 8.12; P = 0.0002）和第三个潜在变量(因素3，RR, 3.14; 95% CI, 1.56 ~ 6.31；P = 0.0013)，这代表了无家可归、入狱、滥交、静脉注射毒品和其他毒品使用的综合影响。多变量模型在检测入院MRSA方面比任何单一风险测量具有更高的灵敏度，并且在46%至58%的入院患者中，允许从入院监测培养中检测出78%至90%的入院MRSA。如果在其他研究中得到证实，入院时的多变量问卷筛查可能会确定入院患者的一个子集，以进行监测培养，从而更有效地识别大多数入院MRSA。
Identifying methicillin-resistant Staphylococcus aureus (MRSA) colonization or infection present at admission has become important in reducing subsequent nosocomial transmission, but the most efficient surveillance methods remain to be defined. We performed anterior nares surveillance cultures of all patients upon admission to and discharge from the general internal medicine floor in our community hospital over a 7-week period, and patients completed a questionnaire on MRSA risk factors. Of the 401 patients, 41 (10.2%) had MRSA upon admission. Of the 48 risk measures analyzed, 10 were significantly associated with admission MRSA, and 7 of these were independently associated in stepwise logistic regression analysis. Factor analysis identified eight latent variables that contained most of the predictive information in the 48 risk measures. Repeat logistic regression analysis including the latent variables revealed three independent risk measures for admission MRSA: a nursing home stay (relative risk [RR], 6.18; 95% confidence interval [95% CI], 3.56 to 10.72; P < 0.0001), prior MRSA infection (RR, 3.97; 95% CI, 1.94 to 8.12; P = 0.0002), and the third latent variable (factor 3; RR, 3.14; 95% CI, 1.56 to 6.31; P = 0.0013), representing the combined effects of homelessness, jail stay, promiscuity, intravenous drug use, and other drug use. Multivariable models had greater sensitivity at detecting admission MRSA than any single risk measure and allowed detection of 78% to 90% of admission MRSA from admission surveillance cultures on 46% to 58% of admissions. If confirmed in additional studies, multivariable questionnaire screening at admission might identify a subset of admissions for surveillance cultures that would more efficiently identify most admission MRSA.