重症监护病房创伤患者获得耐甲氧西林金黄色葡萄球菌（MRSA）的危险因素。

Risk factors for acquisition of methicillin-resistant Staphylococcus aureus (MRSA) by trauma patients in the intensive care unit.

作者信息

Marshall C, Wolfe R, Kossmann T, Wesselingh S, Harrington G, Spelman D

机构信息

Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.

出版信息

J Hosp Infect. 2004 Jul;57(3):245-52. doi: 10.1016/j.jhin.2004.03.024.

DOI:10.1016/j.jhin.2004.03.024

PMID:15236855

Abstract

In a previous study in the intensive care unit (ICU) of the Alfred Hospital, Melbourne, Australia, it was demonstrated that trauma patients were at particular risk of becoming colonized by methicillin-resistant Staphylococcus aureus (MRSA). We examined risk factors for MRSA acquisition in these patients using a cohort study comparing the 31 patients who acquired MRSA with 65 who did not. Data collected included ICU length of stay (LOS), mechanism of trauma, site of injury, type of surgery, trauma severity and antibiotic usage. Odds ratios (OR) were determined and adjusted for LOS. LOS in the ICU was a significant univariate predictor of MRSA acquisition (OR 13.7). When adjusted for LOS, mechanism of trauma (OR 10.4), laparotomy (OR 6.3) and administration of ticarcillin/clavulanic acid (OR 4.5) or glycopeptides (OR 5.9) remained significant. We confirmed our previous finding that LOS was associated with MRSA acquisition. Receipt of antibiotics correlated with reported literature. Novel associations were road trauma as a mechanism and laparotomy.

摘要

在澳大利亚墨尔本阿尔弗雷德医院重症监护病房（ICU）此前开展的一项研究中，已证实创伤患者感染耐甲氧西林金黄色葡萄球菌（MRSA）的风险尤其高。我们采用队列研究，比较了31例感染MRSA的患者和65例未感染MRSA的患者，以此研究这些患者感染MRSA的风险因素。收集的数据包括ICU住院时长（LOS）、创伤机制、损伤部位、手术类型、创伤严重程度及抗生素使用情况。计算优势比（OR）并针对LOS进行校正。ICU住院时长是MRSA感染的一个显著单因素预测指标（OR 13.7）。校正LOS后，创伤机制（OR 10.4）、剖腹手术（OR 6.3）以及给予替卡西林/克拉维酸（OR 4.5）或糖肽类药物（OR 5.9）仍具有显著性。我们证实了之前的发现，即住院时长与MRSA感染相关。抗生素的使用情况与已发表文献相符。新发现的关联因素是道路创伤这一机制和剖腹手术。