Solberg C O
Department of Medicine, Haukeland Hospital, Bergen, Norway.
Scand J Infect Dis. 2000;32(6):587-95. doi: 10.1080/003655400459478.
Methicillin-resistant Staphylococcus aureus (MRSA) has become a major nosocomial pathogen in many hospitals worldwide. Even more alarming, MRSA strains that are vancomycin intermediate-susceptible are isolated with increasing frequency, making therapy for staphylococcal infections even more difficult and prevention more important than ever. Spread of S. aureus in hospitals and infection control measures are reviewed. The major sources of S. aureus in hospitals are septic lesions and carriage sites of patients and personnel. Carriage often precedes infection. The anterior nares are the most consistent carriage site, followed by the perineal area. Skin contamination and aerial dissemination vary markedly between carriers and are most pronounced for combined nasal and perineal carriers. The principal mode of transmission is via transiently contaminated hands of hospital personnel. Airborne transmission seems important in the acquisition of nasal carriage. Infection control strategies include screening and isolation of newly admitted patients suspected of carrying MRSA or S. aureus with intermediáte resistance to vancomycin, implementation of an infection control program to prevent transmission of resistant strains between patients and hospital personnel, and institution of a proper antibiotic policy to minimize antibiotic resistance development. MRSA carriers should be treated with intranasal antibiotics, e.g. mupirocin, and skin disinfectants to eliminate carriage. Education of hospital personnel is essential. Improved knowledge about the best ways to ensure favourable infection control practices is needed. Active intervention against the spread of MRSA is important.
耐甲氧西林金黄色葡萄球菌（MRSA）已成为全球许多医院主要的医院病原体。更令人担忧的是，对万古霉素中度敏感的MRSA菌株分离频率日益增加，这使得葡萄球菌感染的治疗更加困难，预防也比以往任何时候都更加重要。本文综述了金黄色葡萄球菌在医院的传播情况及感染控制措施。医院中金黄色葡萄球菌的主要来源是患者和医护人员的感染性病灶及携带部位。携带通常先于感染发生。前鼻孔是最常见的携带部位，其次是会阴部。携带者之间的皮肤污染和空气传播差异显著，在鼻腔和会阴部联合携带者中最为明显。主要传播途径是通过医院工作人员被短暂污染的手。空气传播在鼻腔携带的获得过程中似乎很重要。感染控制策略包括对疑似携带MRSA或对万古霉素有中度耐药性的金黄色葡萄球菌的新入院患者进行筛查和隔离，实施感染控制计划以防止耐药菌株在患者和医院工作人员之间传播，以及制定适当的抗生素政策以尽量减少抗生素耐药性的产生。MRSA携带者应使用鼻内抗生素（如莫匹罗星）和皮肤消毒剂进行治疗以消除携带。对医院工作人员的教育至关重要。需要提高对确保良好感染控制措施的最佳方法的认识。积极干预MRSA的传播很重要。
