Risk Factors And Clinical Outcomes Of Hospital-Acquired MRSA Infections In Chongqing, China
Risk Factors And Clinical Outcomes Of Hospital-Acquired MRSA Infections In Chongqing, China
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中国重庆市医院获得性 MRSA 感染的危险因素和临床结果
DOI：
10.2147/idr.s223536
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发表时间：
2019-01-01
影响因子：
3.9
通讯作者：
Yao, Chunyan
中科院分区：
文献类型：
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作者：
Mao, Ping;Peng, Ping;Yao, Chunyan
背景：耐甲氧西林金黄色葡萄球菌（MRSA）是具有多药耐药特征的医院感染的常见病原体。它的传播和流行病对医院感染控制构成了巨大挑战。这项研究旨在确定医院获得的MRSA（HA-MRSA）感染的危险因素，并研究其临床结果，制定感染控制策略并改善患者的结果。 2018年1月至2018年12月，中华人民共和国的西南医院，与对照患者一起。在这项研究中，有251例MRSA医生感染患者，有339例甲氧西林敏感的金黄色葡萄球菌菌株（MSSA）肾上腺素感染患者，包括300例非葡萄球菌金黄色葡萄球菌感染的患者。分析显示了中央静脉内静脉内（中央静脉内静脉内）的存在。优势比[OR]，1.932; 95％的置信区间[CI]，1.074-3.477; p = 0.028），痰液
Background Methicillin-resistant Staphylococcus aureus (MRSA) is a common pathogen of hospital infection with multi-drug resistant characteristics. Its spread and epidemic pose great challenges to nosocomial infection control. This study was aimed to identify risk factors for hospital-acquired MRSA (HA-MRSA) infections and investigate its clinical outcome, developing infection control strategies and improving patient outcomes. Methods A retrospective case-case-control study was conducted to compare patients in Southwest Hospital, Chongqing, People's Republic of China from January 2018 to December 2018 with control patients. In this study, 251 patients with MRSA nosocomial infection, 339 patients with methicillin-sensitive Staphylococcus aureus strains (MSSA) nosocomial infection, and 300 patients with non-Staphylococcus aureus infection were included. Results Multivariate analysis showed that presence of central venous catheters (odds ratio [OR], 1.932; 95% confidence interval [CI], 1.074–3.477; P=0.028), sputum suction (OR, 2.887; 95% CI, 1.591–5.240; p<0.001), and total hospital stays more than 30 days (OR, 3.067; 95% CI, 2.063–4.559; P<0.001) were independent risk factors for HA-MRSA. Renal insufficiency (OR, 2.744; 95% CI, 1.089–6.914; P=0.032) and receipt of immunosuppressors (OR, 3.140; 95% CI, 1.284–7.678; P=0.012) were independent predictors of poor prognosis of MRSA nosocomial infection. Moreover, empirical use of antibiotics (OR, 0.514; 95% CI, 0.282–0.935; P=0.029) was a protective factor for poor prognosis of MRSA nosocomial infection. In-hospital mortality in the MRSA group was not statistically significant compared with the other two groups; however, the rate of poor prognosis in the MRSA group was higher than that of the MSSA group (27.5% vs 17.1%, χ2=9.200, P=0.002) and the control group (27.5% vs 16.0%, χ2=19.190, P=0.001). Conclusion Our results have shown presence of central venous catheters, sputum suction, and total hospital stays more than 30 days were associated with nosocomial MRSA infection. Patients with renal insufficiency and immunosuppressive therapy were more likely to cause poor prognosis with MRSA infection, and the empirical use of antibiotics can effectively reduce the adverse clinical outcomes caused by MRSA infection. Based on above findings, strategies to control MRSA infection should emphasize more attention to these patients and appropriate empirical use of antibiotics.