Regional Epidemiology of Methicillin-Resistant Staphylococcus aureus Among Adult Intensive Care Unit Patients Following State-Mandated Active Surveillance.
Regional Epidemiology of Methicillin-Resistant Staphylococcus aureus Among Adult Intensive Care Unit Patients Following State-Mandated Active Surveillance.
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在国家强化监测后，成人重症监护病房患者中耐甲氧西林的葡萄球菌金黄色葡萄球菌的区域流行病学。
DOI：
10.1093/cid/cix1056
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发表时间：
2018-05-02
期刊：
影响因子：
--
通讯作者：
Prevention Epicenters Program, Centers for Disease Control and Prevention
中科院分区：
文献类型：
--
作者：
Lin MY;Hayden MK;Lyles RD;Lolans K;Fogg LF;Kallen AJ;Weber SG;Weinstein RA;Trick WE;Prevention Epicenters Program, Centers for Disease Control and Prevention
2007年，伊利诺斯州成为美国第一个强制监测耐甲氧西林金黄色葡萄球菌（MRSA）的州。伊利诺伊州的法律适用于重症监护病房（ICU）患者；发现有MRSA定植的病人需要采取接触预防措施。然而，通过立法“搜索和隔离”的方法来减少重症患者的MRSA负担的有效性尚不确定。我们评估了在强制性主动监测开始后的5年内，MRSA定殖率是否下降。伊利诺斯州芝加哥市所有ICU床位≥10张的医院均有资格参加为期一天的连续点患病率调查。我们使用鼻腔和腹股沟拭子培养评估了调查时在场的成年ICU患者的MRSA定植情况。主要结果是随着时间的推移，整个地区的MRSA定殖流行率。所有25家符合条件的医院（51家icu）参加了8个调查期间（2008-2013年）的连续点患病率调查。共有3909例成人ICU患者参与了点状流行调查，其中432例（11.1%）发现MRSA定植（95%可信区间[CI]， 10.1% ~ 12.0%）。在研究期间，MRSA在患者中的定殖率没有变化；MRSA定植的年相对危险度为0.97 （95% CI, 0.89 - 1.05; P = 0.48）。在立法规定的MRSA主动监测期间，重症成人患者的MRSA定植率没有下降。我们的研究结果强调了将法定的MRSA主动监测作为减少ICU患者MRSA定植负担的策略的局限性。
In 2007, Illinois became the first state in the United States to mandate active surveillance of methicillin-resistant Staphylococcus aureus (MRSA). The Illinois law applies to intensive care unit (ICU) patients; contact precautions are required for patients found to be MRSA colonized. However, the effectiveness of a legislated “search and isolate” approach to reduce MRSA burden among critically ill patients is uncertain. We evaluated whether the prevalence of MRSA colonization declined in the 5 years after the start of mandatory active surveillance. All hospitals with an ICU having ≥10 beds in Chicago, Illinois, were eligible to participate in single-day serial point prevalence surveys. We assessed MRSA colonization among adult ICU patients present at time of survey using nasal and inguinal swab cultures. The primary outcome was region-wide MRSA colonization prevalence over time. All 25 eligible hospitals (51 ICUs) participated in serial point prevalence surveys over 8 survey periods (2008–2013). A total of 3909 adult ICU patients participated in the point prevalence surveys, with 432 (11.1%) found to be colonized with MRSA (95% confidence interval [CI], 10.1%–12.0%). The MRSA colonization prevalence among patients was unchanged during the study period; year-over-year relative risk for MRSA colonization was 0.97 (95% CI, .89–1.05; P = .48). MRSA colonization prevalence among critically ill adult patients did not decline during the time period following legislatively mandated MRSA active surveillance. Our findings highlight the limits of legislated MRSA active surveillance as a strategy to reduce MRSA colonization burden among ICU patients.
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DOI：
10.1056/nejmoa1113849
发表时间：
2013-02-07
期刊：
The New England journal of medicine
影响因子：
--
作者：
Climo MW;Yokoe DS;Warren DK;Perl TM;Bolon M;Herwaldt LA;Weinstein RA;Sepkowitz KA;Jernigan JA;Sanogo K;Wong ES
通讯作者：
Wong ES
影响因子：
11.8
作者：
Nijssen, S;Bonten, MJM;Weinstein, RA
通讯作者：
Weinstein, RA
影响因子：
158.5
作者：
Huang, Susan S.;Septimus, Edward;Platt, Richard
通讯作者：
Platt, Richard
影响因子：
120.7
作者：
Harris, Anthony D.;Pineles, Lisa;Morgan, Daniel J.
通讯作者：
Morgan, Daniel J.
影响因子：
4.5
作者：
Martin, Elise M.;Russell, Dana;Uslan, Daniel Z.
通讯作者：
Uslan, Daniel Z.