Methicillin-resistant Staphylococcus aureus outbreak in an intensive care nursery:: Potential for interinstitutional spread
Methicillin-resistant Staphylococcus aureus outbreak in an intensive care nursery:: Potential for interinstitutional spread
复制标题
DOI：
10.1097/inf.0b013e3180616ce4
复制
发表时间：
2007-08-01
影响因子：
3.6
通讯作者：
Kaye, Keith S.
中科院分区：
文献类型：
--
作者：
McDonald, Jay R.;Carriker, Charlene M.;Kaye, Keith S.
背景资料：2005年7个月期间，我院重症监护室发生了一起MRSA感染的暴发疫情。方法：采取加强手卫生和接触预防措施，控制MRSA感染。对所有新生儿进行主动监测培养，包括机构间转移。一个队列单位专门用于新生儿MRSA。对分离株进行脉冲场凝胶电泳以确定相关性。我们调查了转运医院，以评估MRSA的活动和监测的做法，在他们的nursery.Results：25新生儿与MRSA定植，其中9个有临床感染。来自本次暴发的21名新生儿中有18名的分离株与来自先前聚集性的4名新生儿的分离株相同，包括从另一机构转移后获得的1名分离株。9个月期间的入院和出院日志显示，460例入院患者中有127例（27.6%）来自34家医院，460例患者中有247例（53.7%）出院至32家医院。在30家对我们的调查作出回应的转院医院中，MRSA活动发生在28家（7%）1级托儿所中的2家，11家（36%）2级托儿所中的4家和10家（60%）3级托儿所中的6家。9的30家医院（30%）进行了一些积极的surveillance.Conclusions：机构间转移可以发挥作用，在新生儿托儿所的MRSA爆发的启动和传播。地区托儿所的MRSA负担和转移率影响MRSA医院间传播的可能性，并可能证明有关MRSA监测和医院间沟通的政策变化是合理的。
Background: After surveillance surveys documented the absence of methicillin-resistant Staphylococcus aureus (MRSA) in our intensive care nursery, an outbreak of MRSA infection occurred there during a 7-month period in 2005.Methods: Control measures included reinforcement of hand hygiene and contact precautions procedures. Active surveillance cultures were obtained on all neonates, including interinstitutional transfers. A cohort unit was dedicated exclusively for neonates with MRSA. Pulsed-field gel electrophoresis was performed on isolates to determine relatedness. We surveyed transferring hospitals to evaluate MRSA activity and surveillance practices in their nurseries.Results: Twenty-five neonates were colonized with MRSA; 9 of these had clinical infections. Isolates from 18 of 21 neonates from this outbreak and 4 neonates from a previous cluster were identical, including I isolate obtained upon transfer from another institution. Admission and discharge logs from a 9-month period showed that 127 of 460 admissions (27.6%) were admitted from 34 hospitals, and 247 of 460 (53.7%) were discharged to 32 hospitals. Among 30 transferring hospitals responding to our survey, MRSA activity occurred in 2 of 28 (7%) level 1 nurseries, 4 of 11 (36%) level 2 nurseries and 6 of 10 (60%) level 3 nurseries. Nine of the 30 hospitals (30%) performed some active surveillance.Conclusions: Interinstitutional transfer can play a role in the initiation and propagation of MRSA outbreaks in neonatal nurseries. The burden of MRSA in area nurseries and the rate of transfers affect the potential for interhospital spread of MRSA and may justify changes in policy regarding surveillance for MRSA and communication between hospitals.