Khoury Jad, Jones Marilyn, Grim Autumn, Dunne Wm Michael, Fraser Vicky
Department of Internal Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
Infect Control Hosp Epidemiol. 2005 Jul;26(7):616-21. doi: 10.1086/502590.
To describe an outbreak of hospital-acquired MRSA in a NICU and to identify the risk factors for, outcomes of, and interventions that eliminated it.
An 18-bed, level III-IV NICU in a community hospital.
Interventions to control MRSA included active surveillance, aggressive contact isolation, and cohorting and de-colonization of infants and HCWs with MRSA. A case-control study was performed to compare infants with and without MRSA.
A cluster of 6 cases of MRSA infection between September and October 2001 represented an increased attack rate of 21.2% compared with 5.3% in the previous months. Active surveillance identified unsuspected MRSA colonization in 6 (21.4%) of 28 patients and 6 (5.5%) of 110 HCWs screened. They were all successfully decolonized. There was an increased risk of MRSA colonization and infection among infants with low birth weight or younger gestational age. Multiple gestation was associated with an increased risk of colonization (OR, 37.5; CI95, 3.9-363.1) and infection (OR, 5.36; CI95, 1.37-20.96). Gavage feeding (OR, 10.33; CI95, 1.28-83.37) and intubation (OR, 5.97; CI95, 1.22-29.31) were associated with increased risk of infection. Infants with MRSA infection had a significantly longer hospital stay than infants without MRSA (51.83 vs 21.46 days; P = .003). Rep-PCR with mec typing and PVL analysis confirmed the presence of a single common strain of hospital-acquired MRSA.
Active surveillance, aggressive implementation of contact isolation, cohorting, and decolonization effectively eradicated MRSA from the NICU for 2 1/2 years following the outbreak.
描述新生儿重症监护病房（NICU）发生的医院获得性耐甲氧西林金黄色葡萄球菌（MRSA）感染暴发情况，并确定感染的危险因素、结局以及消除感染的干预措施。
一家社区医院中拥有18张床位的Ⅲ - Ⅳ级NICU。
控制MRSA的干预措施包括主动监测、积极的接触隔离、对感染MRSA的婴儿和医护人员进行分组护理及去定植。开展病例对照研究以比较感染MRSA和未感染MRSA的婴儿。
2001年9月至10月间发生的6例MRSA感染聚集性病例，与前几个月5.3%的发病率相比，攻击率增至21.2%。主动监测发现，在28例接受筛查的患者中有6例（21.4%）以及110名医护人员中有6例（5.5%）存在未被怀疑的MRSA定植。他们均成功实现去定植。低出生体重或孕周较小的婴儿发生MRSA定植和感染的风险增加。多胎妊娠与定植风险增加（比值比[OR]，37.5；95%置信区间[CI95]，3.9 - 363.1）及感染风险增加（OR，5.36；CI95，1.37 - 20.96）相关。管饲喂养（OR，10.33；CI95，1.28 - 83.37）和插管（OR，5.97；CI95，1.22 - 29.31）与感染风险增加相关。感染MRSA的婴儿住院时间显著长于未感染MRSA的婴儿（51.83天对21.46天；P = 0.003）。采用mec分型和杀白细胞素（PVL）分析的重复聚合酶链反应（Rep-PCR）证实存在单一的医院获得性MRSA常见菌株。
主动监测、积极实施接触隔离、分组护理及去定植措施在暴发后的2年半时间里有效根除了NICU中的MRSA。
