Modeling the invasion of community-acquired methicillin-resistant Staphylococcus aureus into hospitals.
Modeling the invasion of community-acquired methicillin-resistant Staphylococcus aureus into hospitals.
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DOI：
10.1086/595844
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发表时间：
2009-02-01
期刊：
影响因子：
--
通讯作者：
Ruan S
中科院分区：
文献类型：
--
作者：
D'Agata EM;Webb GF;Horn MA;Moellering RC Jr;Ruan S
耐甲氧西林金黄色葡萄球菌（MRSA）传统上与医院感染有关。最近，一种新的MRSA菌株出现并在社区中迅速传播，在年轻健康的个体中造成严重感染。初步报告暗示，社区获得性MRSA（CA-MRSA）菌株的特定克隆（USA 300）正在渗透医院并取代传统的医院获得性MRSA菌株。如果属实，这一事件将产生严重后果，因为医院中的CA-MRSA感染将发生在更虚弱的老年患者人群中。开发了一个确定性数学模型，以表征导致CA-MRSA取代医院获得性MRSA的因素，并量化旨在限制CA-MRSA在医疗保健环境中传播的干预措施的有效性。该模型强烈表明，CA-MRSA将成为医院和卫生保健设施中的主要MRSA菌株。这种优势菌株的逆转将发生作为一个结果，记录扩大社区水库和增加流入医院的个人谁港CA-MRSA。CA-MRSA将竞争性排除医院获得性MRSA，CA-MRSA感染的严重程度增加，导致住院时间延长和CA-MRSA的院内储存量增加。改善手部卫生的依从性和CA-MRSA携带者的筛查和去殖民化是有效的策略。然而，手部卫生具有最大的益处回报，并且如果依从性得到优化，则其他策略可能具有最小的附加益处。
Methicillin-resistant Staphylococcus aureus (MRSA) has traditionally been associated with infections in hospitals. Recently, a new strain of MRSA has emerged and rapidly spread in the community, causing serious infections among young, healthy individuals. Preliminary reports imply that a particular clone (USA300) of a community-acquired MRSA (CA-MRSA) strain is infiltrating hospitals and replacing the traditional hospital-acquired MRSA strains. If true, this event would have serious consequences, because CA-MRSA infections in hospitals would occur among a more debilitated, older patient population. A deterministic mathematical model was developed to characterize the factors contributing to the replacement of hospital-acquired MRSA with CA-MRSA and to quantify the effectiveness of interventions aimed at limiting the spread of CA-MRSA in health care settings. The model strongly suggests that CA-MRSA will become the dominant MRSA strain in hospitals and health care facilities. This reversal of dominant strain will occur as a result of the documented expanding community reservoir and increasing influx into the hospital of individuals who harbor CA-MRSA. Competitive exclusion of hospital-acquired MRSA by CA-MRSA will occur, with increased severity of CA-MRSA infections resulting in longer hospitalizations and a larger in-hospital reservoir of CA-MRSA. Improving compliance with hand hygiene and screening for and decolonization of CA-MRSA carriers are effective strategies. However, hand hygiene has the greatest return of benefits and, if compliance is optimized, other strategies may have minimal added benefit.
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158.5
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