Value of performing active surveillance cultures on intensive care unit discharge for detection of methicillin-resistant Staphylococcus aureus
Value of performing active surveillance cultures on intensive care unit discharge for detection of methicillin-resistant Staphylococcus aureus
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DOI：
10.1086/518348
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发表时间：
2007-06-01
影响因子：
4.5
通讯作者：
Perencevich, Eli N.
中科院分区：
文献类型：
--
作者：
Furuno, Jon P.;Harris, Anthony D.;Perencevich, Eli N.
Objective.目的探讨重症监护病房（ICU）出院患者主动监测培养检测耐甲氧西林金黄色葡萄球菌（MRSA）的价值。前瞻性队列研究。三级保健医院的内科ICU（MICU）和外科ICU（SICU）。我们分析了2001年1月17日至2004年12月31日期间入住MICU或SICU的成人患者的数据。所有参与者都在ICU住院至少48小时，并在ICU入院和出院时进行了前鼻孔标本的监测培养。排除ICU中MRSA临床培养阳性的患者。在2，918例符合条件的患者中，178例（6%）在ICU入院时被MRSA定植，65例（2%）在ICU获得MRSA，并通过出院监测培养结果进行鉴定。经出院培养结果证实MRSA定植的患者在ICU出院后在非ICU病房住院853天，占ICU出院患者在非ICU病房住院期间MRSA定植总天数的27%。在ICU出院时收集的鼻孔标本的监测培养确定了很大比例的MRSA定植患者，这些患者仅根据临床培养或入院监测培养的结果无法确定。此外，对于从ICU出院的患者，这些患者在非ICU病房住院期间MRSA定植天数占总天数的很大比例。
Objective. To quantify the value of performing active surveillance cultures for detection of methicillin-resistant Staphylococcus aureus (MRSA) on intensive care unit (ICU) discharge.Design. Prospective cohort study.Setting. Medical ICU (MICU) and surgical ICU (SICU) of a tertiary care hospital.Participants. We analyzed data on adult patients who were admitted to the MICU or SICU between January 17, 2001, and December 31, 2004. All participants had a length of ICU stay of at least 48 hours and had surveillance cultures of anterior nares specimens performed on ICU admission and discharge. Patients who had MRSA-positive clinical cultures in the ICU were excluded.Results. Of 2,918 eligible patients, 178 (6%) were colonized with MRSA on ICU admission, and 65 (2%) acquired MRSA in the ICU and were identified by results of discharge surveillance cultures. Patients with MRSA colonization confirmed by results of discharge cultures spent 853 days in non-ICU wards after ICU discharge, which represented 27% of the total number of MRSA colonization-days during hospitalization in non-ICU wards for patients discharged from the ICU.Conclusions. Surveillance cultures of nares specimens collected at ICU discharge identified a large percentage of MRSA-colonized patients who would not have been identified on the basis of results of clinical cultures or admission surveillance cultures alone. Furthermore, these patients were responsible for a large percentage of the total number of MRSA colonization-days during hospitalization in non-ICU wards for patients discharged from the ICU.