Wertheim H F L, Vos M C, Boelens H A M, Voss A, Vandenbroucke-Grauls C M J E, Meester M H M, Kluytmans J A J W, van Keulen P H J, Verbrugh H A
Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Centre, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
J Hosp Infect. 2004 Apr;56(4):321-5. doi: 10.1016/j.jhin.2004.01.026.
In the Netherlands, less than 1% of clinical isolates of Staphylococcus aureus are methicillin-resistant (MRSA). A national search and destroy policy prevents MRSA from becoming endemic. Some MRSA outbreaks cannot be related to patients at risk for MRSA carriage. This study was designed to measure the prevalence of MRSA among patients without risk factors for MRSA carriage at the time of admission to the hospital. In four Dutch hospitals, patients admitted to non-surgical departments in the period 1999-2000 were screened for MRSA nasal carriage. Nasal swabs were streaked on 5% sheep blood agar (BA), submerged in a selective broth, and incubated for two to three days at 35 degrees C. Colonies suspected of being S. aureus were identified with an agglutination test. Susceptibility testing was performed by an automated system and additional oxacillin disk diffusion. Methicillin resistance was confirmed by a DNA hybridization test and mecA PCR. MRSA strains were genotyped by pulsed-field gel electrophoresis (PFGE). Twenty-four percent (2332/9859) of the patients were S. aureus nasal carriers. Only three (0.03%) patients were MRSA carriers. These patients were not repatriated, nor known to be MRSA carriers before screening. Genotyping revealed that the strains were not clonally related and were not related to MRSA outbreaks in the hospital where the patients were admitted. We conclude that at routine admission to a Dutch hospital (excluding high-risk foreign admissions) the MRSA prevalence is low (0.03%), due to the Dutch search and destroy policy and restrictive antibiotic prescribing.
在荷兰，金黄色葡萄球菌临床分离株中耐甲氧西林的比例不到1%。一项全国性的“搜索并消灭”政策防止了耐甲氧西林金黄色葡萄球菌（MRSA）成为地方病。一些MRSA暴发与有MRSA携带风险的患者无关。本研究旨在测量入院时无MRSA携带风险因素的患者中MRSA的流行率。在荷兰的四家医院，对1999年至2000年期间入住非外科科室的患者进行了MRSA鼻腔携带情况筛查。将鼻拭子接种在5%绵羊血琼脂（BA）上，浸入选择性肉汤中，并在35℃下培养两到三天。通过凝集试验鉴定疑似金黄色葡萄球菌的菌落。药敏试验通过自动化系统和额外的苯唑西林纸片扩散法进行。通过DNA杂交试验和mecA PCR确认耐甲氧西林情况。通过脉冲场凝胶电泳（PFGE）对MRSA菌株进行基因分型。24%（2332/9859）的患者为金黄色葡萄球菌鼻腔携带者。只有三名（0.03%）患者为MRSA携带者。这些患者未被遣返，在筛查前也不知道是MRSA携带者。基因分型显示，这些菌株在克隆上不相关，也与患者所入住医院的MRSA暴发无关。我们得出结论，由于荷兰的“搜索并消灭”政策和严格的抗生素处方，在荷兰医院常规入院时（不包括高风险的外国患者入院），MRSA流行率较低（0.03%）。
