Thompson M
Department of Vascular Surgery, St George's Hospital, London, UK.
Eur J Vasc Endovasc Surg. 2006 Jun;31(6):609-15. doi: 10.1016/j.ejvs.2005.12.009. Epub 2006 Feb 3.
In 2003, 18% of all admissions to our vascular ward were colonised by MRSA, with an MRSA infection rate of 10.6%. Standard practice was to segregate patients with proven MRSA from the rest of the patient pool. After a prospective audit, regression analysis was used to identify factors that could stratify patients into high and low risk for MRSA colonisation. A change in isolation policy was introduced that segregated patients according to their risk of MRSA acquisition, and isolated all patients undergoing prosthetic vascular reconstruction. Antibiotic policy was also altered. This audit reports the impact of these changes on MRSA colonisation and infection rates.
The MRSA status of patients during 777 in-patient episodes was prospectively recorded during three time spans; period 1 (November 2002-April 2003) before the change in isolation and antibiotic policy and, periods 2 (August-December 2003) and 3 (October 2004-January 2005) after the change in policy.
Hospital acquired MRSA colonisation was reduced from 10.6% in period 1, to 1.1 and 1.4% in periods 2 and 3, respectively (p<0.001). Similarly, MRSA infection rates fell from 10.6 to 2.9 and 0.9% over the same time frame (p<0.001). The most dramatic changes in MRSA infection rates occurred in patients undergoing aneurysm repair (MRSA infection 30.1% in period 1 vs. 3.9 and 2.9% in periods 2 and 3) and lower limb revascularization (31 vs. 0 vs. 4.2%). Stepwise regression analysis revealed that the system of isolation was a significant factor reducing MRSA infection and colonisation rates (p<0.001).
These data demonstrate that a change in infection control policy can significantly reduce MRSA infection in a vascular unit.
2003年，我院血管病病房所有入院患者中有18%被耐甲氧西林金黄色葡萄球菌（MRSA）定植，MRSA感染率为10.6%。标准做法是将已证实感染MRSA的患者与其他患者隔离开来。经过前瞻性审计，采用回归分析来确定可将患者分为MRSA定植高风险和低风险的因素。引入了一项隔离政策的改变，根据患者获得MRSA的风险对其进行隔离，并隔离所有接受人工血管重建的患者。抗生素政策也有所改变。本审计报告了这些变化对MRSA定植和感染率的影响。
前瞻性记录了777例住院患者在三个时间段内的MRSA状况；第1阶段（2002年11月至2003年4月）在隔离和抗生素政策改变之前，以及第2阶段（2003年8月至12月）和第3阶段（2004年10月至2005年1月）在政策改变之后。
医院获得性MRSA定植率从第1阶段的10.6%分别降至第2阶段和第3阶段的1.1%和1.4%（p<0.001）。同样，MRSA感染率在同一时间框架内从10.6%降至2.9%和0.9%（p<0.001）。MRSA感染率变化最显著的是接受动脉瘤修复的患者（第1阶段MRSA感染率为30.1%，第2阶段和第3阶段分别为3.9%和2.9%）以及下肢血管重建患者（分别为31%、0%和4.2%）。逐步回归分析显示，隔离制度是降低MRSA感染和定植率的一个重要因素（p<0.001）。
这些数据表明，感染控制政策的改变可显著降低血管病科室的MRSA感染。
