Universal screening for methicillin-resistant Staphylococcus aureus at hospital admission and nosocomial infection in surgical patients
Universal screening for methicillin-resistant Staphylococcus aureus at hospital admission and nosocomial infection in surgical patients
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DOI：
10.1001/jama.299.10.1149
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发表时间：
2008-03-12
影响因子：
120.7
通讯作者：
Pittet, Didier
中科院分区：
文献类型：
--
作者：
Harbarth, Stephan;Fankhauser, Carolina;Pittet, Didier
背景 专家和政策制定者一再呼吁在入院时进行普遍筛查，以减少院内耐甲氧西林金黄色葡萄球菌 (MRSA) 感染。目的 确定早期 MRSA 检测策略对外科患者院内 MRSA 感染率的影响。设计、环境和患者 2004 年 7 月至 2006 年 5 月期间，在瑞士一家教学医院对 21 754 名外科患者进行了前瞻性介入队列研究，使用交叉设计比较 2 种 MRSA 控制策略（入院快速筛查加标准感染控制措施与单独标准感染控制措施）。根据预先设定的议程，纳入包括不同外科专业的12个外科病房，分配到对照组或干预组，为期9个月，然后切换到另一组，再进行9个月。 干预 在快速筛查干预期间，对入住干预病房超过24小时的患者在入院前或入院时通过快速多重聚合酶链反应进行筛查。在干预期（n= 10 844）和对照期（n= 10 910），所有病房的MRSA患者均采用标准感染控制措施，包括对MRSA携带者进行接触隔离、使用专用材料（如需要时使用隔离衣、手套、口罩）、调整MRSA携带者围手术期抗生素预防、计算机化MRSA警报系统和局部去定植（鼻用莫匹罗星软膏和洗必泰体）清洗）5天。主要结果指标院内MRSA感染发生率、MRSA手术部位感染以及院内MRSA获得率。结果总体而言，在干预期间对10 844名患者中的10 193名（94%）进行了筛查。筛查发现了 515 名 MRSA 阳性患者 (5.1%)，其中包括 337 名以前未知的 MRSA 携带者。从筛选到通知测试结果的中位时间为 22.5 小时（四分位数范围，12.2-28.2 小时）。在干预期，有 93 名患者（每 1000 患者日 1.11 例）发生院内 MRSA 感染，而对照期则有 76 例患者（每 1000 患者日 0.91 例；调整后的发病率比，1.20；95% 置信区间，0.85-1.69；P=29）。 MRSA手术部位感染率和院内MRSA获得率没有显着变化。干预病房的 93 名感染患者中，有 53 名 (57%) 入院时没有 MRSA，但在住院期间出现了 MRSA 感染。 结论 普遍、快速的 MRSA 入院筛查策略并没有减少 MRSA 流行的外科部门的院内 MRSA 感染，但 MRSA 感染率相对较低。 试验注册已注册。组织标识符：ISRCTN06603006。
Context Experts and policy makers have repeatedly called for universal screening at hospital admission to reduce nosocomial methicillin- resistant Staphylococcus aureus ( MRSA) infection.Objective To determine the effect of an early MRSA detection strategy on nosocomial MRSA infection rates in surgical patients.Design, Setting, and Patients Prospective, interventional cohort study conducted between July 2004 and May 2006 among 21 754 surgical patients at a Swiss teaching hospital using a crossover design to compare 2 MRSA control strategies ( rapid screening on admission plus standard infection control measures vs standard infection control alone). Twelve surgical wards including different surgical specialties were enrolled according to a prespecified agenda, assigned to either the control or intervention group for a 9- month period, then switched over to the other group for a further 9 months.Interventions During the rapid screening intervention periods, patients admitted to the intervention wards for more than 24 hours were screened before or on admission by rapid, multiplex polymerase chain reaction. For both intervention ( n= 10 844) and control ( n= 10 910) periods, standard infection control measures were used for patients with MRSA in all wards and consisted of contact isolation of MRSA carriers, use of dedicated material ( eg, gown, gloves, mask if indicated), adjustment of perioperative antibiotic prophylaxis of MRSA carriers, computerized MRSA alert system, and topical decolonization ( nasal mupirocin ointment and chlorhexidine body washing) for 5 days.Main Outcome Measures Incidence of nosocomial MRSA infection, MRSA surgical site infection, and rates of nosocomial acquisition of MRSA.Results Overall, 10 193 of 10 844 patients ( 94%) were screened during the intervention periods. Screening identified 515 MRSA- positive patients ( 5.1%), including 337 previously unknown MRSA carriers. Median time from screening to notification of test results was 22.5 hours ( interquartile range, 12.2- 28.2 hours). In the intervention periods, 93 patients ( 1.11 per 1000 patient- days) developed nosocomial MRSA infection compared with 76 in the control periods ( 0.91 per 1000 patient- days; adjusted incidence rate ratio, 1.20; 95% confidence interval, 0.85- 1.69; P=. 29). The rate of MRSA surgical site infection and nosocomial MRSA acquisition did not change significantly. Fifty- three of 93 infected patients ( 57%) in the intervention wards were MRSA- free on admission and developed MRSA infection during hospitalization.Conclusion A universal, rapid MRSA admission screening strategy did not reduce nosocomial MRSA infection in a surgical department with endemic MRSA prevalence but relatively low rates of MRSA infection.Trial Registration isrctn. org Identifier: ISRCTN06603006.