Duration of colonization with methicillin-resistant Staphylococcus aureus among patients in the intensive care unit:: Implications for intervention
Duration of colonization with methicillin-resistant Staphylococcus aureus among patients in the intensive care unit:: Implications for intervention
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DOI：
10.1086/500649
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发表时间：
2006-03-01
影响因子：
4.5
通讯作者：
Climo, Michael W.
中科院分区：
文献类型：
--
作者：
Ridenour, Glenn A.;Wong, Edward S.;Climo, Michael W.
目标.确定进入重症监护室（ICU）前和住院期间耐甲氧西林金黄色葡萄球菌（MRSA）定植或感染的持续时间以及MRSA检测阳性患者的特征。前瞻性观察性队列研究。一个综合医疗和冠状动脉护理ICU，在一个427张床位的三级护理退伍军人事务医疗中心有16个单人病房。从2003年1月13日至2003年10月12日，共对720例ICU患者和845例ICU住院患者进行了MRSA检测随访。通过使用进入ICU后48小时内获得的鼻拭子标本的主动监测培养（ASC）检测患者中的MRSA定植，此后每周3次。在回顾了监测培养结果、临床培养结果和病史后，计算了ICU住院期间和进入ICU前的定植持续时间。845例ICU入院患者中有93例（11.0%）在进入ICU时感染了MRSA，21例（2.5%）在ICU住院期间感染了MRSA。在114例与MRSA阳性相关的住院患者中，84例（73.6%）ASCs对MRSA呈阳性，并且ASCs是50例（43.8%）中鉴定MRSA的唯一方法。超过一半的MRSA相关入院患者是从医院病房转来的。38例入院患者在进入ICU前MRSA检测呈阳性（1131天）的总护理床日数比所有MRSA阳性患者的总护理床日数（970天）高出近20%。与MRSA阴性患者相比，MRSA阳性患者入院时进入ICU前的住院时间更长（P <.001），ICU停留时间更长（P <.001），住院总时间更长（P <.001），住院死亡率更高（P <.001）。所有卧床护理天数中有22.8%用于ICU中的MRSA阳性患者，114例MRSA阳性患者中有55例（48.2%）在ICU住院期间被定植。在我们的单位，ASCs是一种有效的手段，以确定MRSA定植的患者入住ICU。不幸的是，大多数确定的患者在进入ICU之前在我们自己的医院停留了很长时间，MRSA定植时间较长。加强努力控制MRSA将不得不考虑MRSA在医院病房内的流行情况，并在未来指导对这些患者的控制工作。
Objectives. To determine the duration of methicillin-resistant Staphylococcus aureus ( MRSA) colonization or infection before entry and during hospitalization in the intensive care unit ( ICU) and the characteristics of patients who tested positive for MRSA.Design. Prospective observational cohort survey.Setting. A combined medical and coronary care ICU with 16 single-bed rooms in a 427-bed tertiary care Veteran Affairs Medical CenterPatients. A total of 720 ICU patients associated with 845 ICU admissions were followed up for the detection of MRSA from January 13, 2003, to October 12, 2003. MRSA colonization was detected in patients by using active surveillance cultures ( ASCs) of nasal swab specimens obtained within 48 hours of ICU entry and 3 times weekly thereafter. The duration of colonization during ICU stay and before ICU entry was calculated after a review of surveillance culture results, clinical culture results, and medical history.Results. Ninety-three ( 11.0%) of 845 ICU admissions involved patients who were colonized with MRSA at the time of ICU entry, and 21 admissions ( 2.5%) involved patients who acquired MRSA during ICU stay. ASCs were positive for MRSA in 84 ( 73.6%) of the 114 admissions associated with MRSA positivity and were the sole means of identifying MRSA in 50 cases ( 43.8%). More than half of the MRSA-associated admissions involved patients who were transferred from hospital wards. The total bed-days of care for 38 admissions involving patients who tested positive for MRSA before ICU entry ( 1131 days) was nearly 20% higher than the total bed-days of care for all admissions associated with MRSA positivity ( 970 days). Admissions involving MRSA-positive patients were associated with a longer length of hospitalization before ICU entry (P < .001), longer length of ICU stay (P < .001), longer overall length of hospitalization ( P < .001), and greater inpatient mortality than admissions involving MRSA-negative patients (P < .001). A total of 22.8% of all bed-care days were dedicated to MRSA-positive patients in the ICU, and 55 ( 48.2%) of 114 admissions associated with MRSA positivity involved patients who were colonized for the duration of their ICU stay.Conclusions. In our unit, ASCs were an effective means to identify MRSA colonization among patients admitted to the ICU. Unfortunately, the majority of identified patients had long durations of stay in our own hospital before ICU entry, with prolonged MRSA colonization. Enhanced efforts to control MRSA will have to account for the prevalence of MRSA within hospital wards and to direct control efforts at these patients in the future.