Not just a matter of size: a hospital-level risk factor analysis of MRSA bacteraemia in Scotland.
Not just a matter of size: a hospital-level risk factor analysis of MRSA bacteraemia in Scotland.
复制标题
DOI：
10.1186/s12879-016-1563-6
复制
发表时间：
2016-05-21
影响因子：
3.7
通讯作者：
Chase-Topping ME
中科院分区：
文献类型：
--
作者：
Gibbons CL;van Bunnik BAD;Blatchford O;Robertson C;Porphyre T;Imrie L;Wilson J;Fitzgerald JR;Woolhouse MEJ;Chase-Topping ME
在世界范围内，有大量的文献研究耐甲氧西林金黄色葡萄球菌（MRSA）菌血症患者水平的危险因素。在医院层面，人们普遍认为MRSA菌血症在大医院更常见。在苏格兰，规模并不能完全解释医院之间观察到的所有差异。本研究的目的是确定苏格兰大陆医院中MRSA菌血症病例的存在和发生率的危险因素。对医院规模、类型和连通性的具体假设进行了检验。使用逻辑回归（模型1:MRSA菌血症的存在/不存在）和泊松回归（模型2:MRSA菌血症的发生率）分析了2007-08财政年度来自198家苏格兰大陆医院（定义为每年至少有一名住院患者）的数据。研究了代表医院规模、类型和连通性的各种措施的风险因素的重要性。在苏格兰，大小并不是确定MRSA菌血症存在和发生率的唯一重要危险因素。只有当医院的连通性超过一定水平时，医院至少有一个MRSA菌血症病例的概率才会随着医院的规模而增加。较高水平的MRSA菌血症与大型、高度联系的教学医院有关，这些医院的患者与家庭工作人员的比例较高。医院在网络内的连接程度可能比医院的规模更能衡量医院患MRSA菌血症的风险。该结果可用于识别高风险医院，这些医院将受益于加强感染控制措施。本文的在线版本（doi:10.1186/s12879-016-1563-6）包含补充材料，授权用户可以使用。
Worldwide, there is a wealth of literature examining patient-level risk factors for methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia. At the hospital-level it is generally accepted that MRSA bacteraemia is more common in larger hospitals. In Scotland, size does not fully explain all the observed variation among hospitals. The aim of this study was to identify risk factors for the presence and rate of MRSA bacteraemia cases in Scottish mainland hospitals. Specific hypotheses regarding hospital size, type and connectivity were examined. Data from 198 mainland Scottish hospitals (defined as having at least one inpatient per year) were analysed for financial year 2007-08 using logistic regression (Model 1: presence/absence of MRSA bacteraemia) and Poisson regression (Model 2: rate of MRSA bacteraemia). The significance of risk factors representing various measures of hospital size, type and connectivity were investigated. In Scotland, size was not the only significant risk factor identified for the presence and rate of MRSA bacteraemia. The probability of a hospital having at least one case of MRSA bacteraemia increased with hospital size only if the hospital exceeded a certain level of connectivity. Higher levels of MRSA bacteraemia were associated with the large, highly connected teaching hospitals with high ratios of patients to domestic staff. A hospital’s level of connectedness within a network may be a better measure of a hospital’s risk of MRSA bacteraemia than size. This result could be used to identify high risk hospitals which would benefit from intensified infection control measures. The online version of this article (doi:10.1186/s12879-016-1563-6) contains supplementary material, which is available to authorized users.