Risk factors for colonization with methicillin-resistant Staphylococcus aureus (MRSA) in patients admitted to an urban hospital:: Emergence of community-associated MRSA nasal carriage
Risk factors for colonization with methicillin-resistant Staphylococcus aureus (MRSA) in patients admitted to an urban hospital:: Emergence of community-associated MRSA nasal carriage
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DOI：
10.1086/430910
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发表时间：
2005-07-15
影响因子：
11.8
通讯作者：
King, MD
中科院分区：
文献类型：
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作者：
Hidron, AI;Kourbatova, EV;King, MD
背景。建议在入院时进行监测培养，以确定耐甲氧西林金黄色葡萄球菌（MRSA）定植的患者，但需要大量资源。我们确定了在公立城市医院接受治疗的患者入院时MRSA定植的患病率和危险因素。入院后48小时内进行前鼻孔培养，为期1个月。进行了病例对照研究和分子分型研究。726例患者中53例（7.3%）的鼻腔培养结果为MRSA阳性，119例（16.4%）的鼻腔培养结果为甲氧西林敏感金黄色葡萄球菌阳性。在多因素分析中，MRSA定植的危险因素包括入院前3个月内使用抗生素（优势比[OR]， 2.5； 95%可信区间[CI]， 1.2 - 5.0），过去12个月内住院（OR, 4.0; 95% CI, 2.0 - 8.2），入院时诊断皮肤或软组织感染（OR, 3.4; 95% CI, 1.5 - 7.9），以及HIV感染。53例MRSA定殖患者中有47例（89%）至少具有上述1种独立危险因素，而673例对照患者中有343例（51%）存在上述危险因素（OR, 7.5; 95% CI, 3.2 - 17.9）。分子分型结果显示，53株MRSA鼻腔分离株中16株（30%）（726株中2.2%）属于USA300社区相关MRSA （CA-MRSA）基因型。患者入院时MRSA定植的流行率很高（17%）。将监测培养限制在已确定的危险因素中>= 1的患者中，可以进行有针对性的筛查。CA-MRSA定植的出现代表了医院内新的、未被识别的MRSA储存库，潜在地增加了水平传播的风险。
Background. Surveillance cultures performed at hospital admission have been recommended to identify patients colonized with methicillin-resistant Staphylococcus aureus (MRSA) but require substantial resources. We determined the prevalence of and risk factors for MRSA colonization at the time of hospital admission among patients cared for at a public urban hospital.Methods. Anterior nares cultures were obtained within 48 h after admission during a 1-month period. A case-control study and molecular typing studies were performed.Results. A total of 53 (7.3%) of 726 patients had a nares culture positive for MRSA, and 119 (16.4%) had a nares culture that was positive for methicillin-susceptible S. aureus. In multivariate analysis, risk factors for MRSA colonization included antibiotic use within 3 months before admission (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.2 - 5.0), hospitalization during the past 12 months (OR, 4.0; 95% CI, 2.0 - 8.2), diagnosis of skin or soft-tissue infection at admission (OR, 3.4; 95% CI, 1.5 - 7.9), and HIV infection. A total of 47 (89%) of 53 case patients colonized with MRSA had at least 1 of these independent risk factors, in contrast to 343 (51%) of 673 control patients (OR, 7.5; 95% CI, 3.2 - 17.9). Molecular typing demonstrated that 16 (30%) of 53 MRSA nares isolates (2.2% of the 726 isolates) belonged to the USA300 community-associated MRSA (CA-MRSA) genotype.Conclusion. The prevalence of MRSA colonization at the time of patient admission was high (17%). Limiting surveillance cultures to patients with >= 1 of the identified risk factors may allow for targeted screening. The emergence of CA-MRSA colonization represents a new, unrecognized reservoir of MRSA within hospitals, potentially increasing the risk for horizontal transmission.