Infection control for a methicillin-resistant Staphylococcus aureus outbreak in an advanced emergency medical service center, as monitored by molecular analysis
Infection control for a methicillin-resistant Staphylococcus aureus outbreak in an advanced emergency medical service center, as monitored by molecular analysis
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DOI：
10.1007/s10156-013-0587-8
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发表时间：
2013-10-01
影响因子：
2.2
通讯作者：
Watanabe, Hiroshi
中科院分区：
文献类型：
--
作者：
Hidaka, Hidenobu;Miura, Miho;Watanabe, Hiroshi
2010年至2011年期间，一家先进的紧急医疗服务中心发生了耐甲氧西林金黄色葡萄球菌（MRSA）爆发。我们的目标是评估MRSA爆发的状态，通过分子分析进行监测。从11例患者的血液标本中分离到28株MRSA，从其他标本（咽、鼻腔等）中分离到28株MRSA。来自12名患者，来自两个环境样品，以及来自其他病房的各一名患者的皮肤、中鼻道和尿液。进行脉冲场凝胶电泳（PFGE）以评估水平传输。PFGE分型结果显示，28株MRSA共有7种PGFE分型，其中11株具有相同的PGFE分型。非选择性使用鼻内莫匹罗星软膏，MRSA监测新的住院患者，并预防直接或间接接触感染。然而，MRSA住院患者的数量并没有迅速减少，PFGE的额外分子分型显示，发现的19种MRSA菌株中有10种（6种中有5种来自血液，13种中有5种来自其他标本）与以前发现的相同。反复进行讲座和查房，并建议员工参与查房。最后，MRSA住院患者的数量在干预后6个多月显著减少。虽然MRSA爆发被认为已经结束，但PFGE的后续分子分型显示水平传播仍在持续。我们的数据表明，在处理MRSA爆发时，各种感染控制措施的组合是必不可少的，使用PFGE进行分子分析的监测有助于确定爆发的状态。
A methicillin-resistant Staphylococcus aureus (MRSA) outbreak occurred in an advanced emergency medical service center between 2010 and 2011. Our objective was to evaluate the status of the MRSA outbreak, as monitored by molecular analysis. Twenty-eight MRSA strains were isolated from blood samples from 11 patients, from other specimens (pharynx, nasal cavity, etc.) from 12 patients, from two environmental samples, and from the skin, middle nasal meatus, and urine of one patient each from other wards. Pulsed-field gel electrophoresis (PFGE) was performed to evaluate horizontal transmission. Molecular typing by PFGE showed that the 28 MRSA strains presented 7 patterns in total, and that 11 of the MRSA strains had the same PGFE pattern. Unselective use of intranasal mupirocin ointment, MRSA monitoring for new inpatients, and prevention of direct or indirect contact infection were performed. However, the number of inpatients with MRSA did not quickly decrease, and additional molecular typing by PFGE showed that 10 of 19 MRSA strains found (5 of 6 from blood, 5 of 13 from other specimens) were the same as those found previously. Lectures and ward rounds were performed repeatedly, and staff participation in ward rounds was suggested. Finally, the number of inpatients with MRSA significantly decreased more than 6 months after the intervention. Although the MRSA outbreak was thought to have ended, follow-up molecular typing by PFGE showed that horizontal transmission persisted. Our data suggest that various combinations of infection control measures are essential when dealing with an MRSA outbreak, and monitoring by molecular analysis using PFGE is useful to identify the status of the outbreak.