Acquisition and Cross-Transmission of Staphylococcus aureus in European Intensive Care Units
Acquisition and Cross-Transmission of Staphylococcus aureus in European Intensive Care Units
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DOI：
10.1086/593126
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发表时间：
2009-02-01
影响因子：
4.5
通讯作者：
Verhoef, Jan
中科院分区：
文献类型：
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作者：
Bloemendaal, Alexander L. A.;Fluit, Ad C.;Verhoef, Jan
目标。研究不同重症监护病房（icu）金黄色葡萄球菌的获取和交叉传播情况。我们进行了一项多中心队列研究。6个国家的6个icu参与。在每个ICU的3个月期间，所有患者在ICU入院时和住院期间都有鼻腔和会阴拭子标本。所有金黄色葡萄球菌分离株均采用spa分型和多位点可变数串联重复分型进行交叉传播分析。共有629例患者入住ICU，其中224例患者在ICU住院期间至少检出1次金黄色葡萄球菌（22%检出耐甲氧西林金黄色葡萄球菌[MRSA]）。共有316例患者在ICU入院时金黄色葡萄球菌检测结果为阴性，并且至少有1次随访拭子样本进行培养，符合获得性分析的条件。ICU住院期间共有45例患者获得金黄色葡萄球菌（31例获得甲氧西林敏感金黄色葡萄球菌[MSSA]， 14例获得MRSA）。在单变量和多变量分析中分析了几个被认为影响金黄色葡萄球菌获得率的因素，包括手部消毒剂的使用量、定植压力、每个护士的床位数量、抗生素的使用、住院时间和ICU环境（单独病房与开放式ICU治疗）。更大的定植压力和每个护士更多的床位数量与更高的MSSA和MRSA获得率相关。ICU环境类型仅与MRSA感染相关，手部消毒液用量仅与MSSA感染相关。在18例（40%）金黄色葡萄球菌感染病例中，可能存在其他患者的交叉传播。定植压力、每位护士的床位数量以及所有患者在私人病房的治疗与ICU的金黄色葡萄球菌感染数量相关。手消毒液用量与MSSA感染病例数相关，与MRSA感染病例数无关。msa和MRSA患者间交叉传播的病例数相当。
OBJECTIVE. To study the acquisition and cross-transmission of Staphylococcus aureus in different intensive care units (ICUs).METHODS. We performed a multicenter cohort study. Six ICUs in 6 countries participated. During a 3-month period at each ICU, all patients had nasal and perineal swab specimens obtained at ICU admission and during their stay. All S. aureus isolates that were collected were genotyped by spa typing and multilocus variable-number tandem-repeat analysis typing for cross-transmission analysis. A total of 629 patients were admitted to ICUs, and 224 of these patients were found to be colonized with S. aureus at least once during ICU stay (22% were found to be colonized with methicillin-resistant S. aureus [MRSA]). A total of 316 patients who had test results negative for S. aureus at ICU admission and had at least 1 follow-up swab sample obtained for culture were eligible for acquisition analysis.RESULTS. A total of 45 patients acquired S. aureus during ICU stay (31 acquired methicillin-susceptible S. aureus [MSSA], and 14 acquired MRSA). Several factors that were believed to affect the rate of acquisition of S. aureus were analyzed in univariate and multivariate analyses, including the amount of hand disinfectant used, colonization pressure, number of beds per nurse, antibiotic use, length of stay, and ICU setting (private room versus open ICU treatment). Greater colonization pressure and a greater number of beds per nurse correlated with a higher rate of acquisition for both MSSA and MRSA. The type of ICU setting was related to MRSA acquisition only, and the amount of hand disinfectant used was related to MSSA acquisition only. In 18 (40%) of the cases of S. aureus acquisition, cross-transmission from another patient was possible.CONCLUSIONS. Colonization pressure, the number of beds per nurse, and the treatment of all patients in private rooms correlated with the number of S. aureus acquisitions on an ICU. The amount of hand disinfectant used was correlated with the number of cases of MSSA acquisition but not with the number of cases of MRSA acquisition. The number of cases of patient-to-patient cross-transmission was comparable for MSSA and MRSA.