Singh Nina, Squier Cheryl, Wannstedt Cheryl, Keyes Lois, Wagener Marilyn M, Cacciarelli Thomas V
Division of Infectious Diseases, Department of Medicine, VA Medical Center, Pittsburgh, PA 15240, USA. nis5+@pitt.edu
Infect Control Hosp Epidemiol. 2006 Feb;27(2):122-6. doi: 10.1086/500651. Epub 2006 Feb 8.
Methicillin-resistant Staphylococcus aureus has emerged as a leading pathogen in transplant recipients and has become endemic in many institutions where transplantation is performed. The role of active surveillance programs based on the detection of colonization in the prevention of S. aureus infection in liver transplant recipients has not been defined.
A total of 47 consecutive patients who underwent liver transplantation during 1996-1999 were compared with 97 patients who received a liver transplant during 2000-2004 after implementation of an intensive intervention program that included use of surveillance cultures to detect nasal and rectal colonization, use of cohorting and contact isolation precautions, and decolonization with intranasal mupirocin therapy.
The rate of new acquisition of S. aureus colonization of nares after transplantation decreased from 45.6% (21 of 46 patients) during the preintervention period to 9.9% (9 of 91 patients) during the postintervention period (P<.001). An increased length of hospital stay (odds ratio, 1.03; 95% confidence interval, 1.01-1.05; P<.002) was associated with new carriage acquisition, and transplantation during the postintervention period (odds ratio, 0.21; 95% confidence interval, 0.08-0.51; P<.001) was independently protective against new carriage. The rate of infection due to S. aureus decreased from 40.4% (19 of 47 patients) during the preintervention period to 4.1% (4 of 97 patients) during the postintervention period (P<.001), and the rate of bacteremia decreased from 25.5% (12 of 47 patients) to 4.1% (4 of 97 patients), respectively (P<.001). Overall, S. aureus infections occurred more frequently among patients with new carriage than among patients who were carriers at the time of transplantation (P<.001) or patients who were noncarriers (P<.001).
Use of active surveillance cultures to detect colonization and implementation of targeted infection control interventions proved to be effective in curtailing new acquisition of S. aureus colonization and in decreasing the rate of S. aureus infection that was endemic in our population of liver transplant recipients.
耐甲氧西林金黄色葡萄球菌已成为移植受者中的主要病原体，并在许多进行移植手术的机构中流行。基于检测定植的主动监测计划在预防肝移植受者金黄色葡萄球菌感染中的作用尚未明确。
将1996 - 1999年期间连续接受肝移植的47例患者与2000 - 2004年实施强化干预计划后接受肝移植的97例患者进行比较。强化干预计划包括使用监测培养物检测鼻腔和直肠定植、采用分组和接触隔离预防措施以及用鼻内莫匹罗星疗法进行去定植。
移植后金黄色葡萄球菌鼻腔定植的新获得率从干预前期的45.6%（46例患者中的21例）降至干预后期的9.9%（91例患者中的9例）（P <.001）。住院时间延长（优势比，1.03；95%置信区间，1.01 - 1.05；P <.002）与新定植获得相关，而干预后期进行移植（优势比，0.21；95%置信区间，0.08 - 0.51；P <.001）对新定植具有独立的保护作用。金黄色葡萄球菌感染率从干预前期的40.4%（47例患者中的19例）降至干预后期的4.1%（97例患者中的4例）（P <.001），菌血症发生率分别从25.5%（47例患者中的12例）降至4.1%（97例患者中的4例）（P <.001）。总体而言，新定植患者中金黄色葡萄球菌感染的发生率高于移植时为定植者（P <.001）或非定植者（P <.001）。
使用主动监测培养物检测定植并实施针对性感染控制干预措施，在减少金黄色葡萄球菌定植的新获得以及降低我们肝移植受者群体中流行的金黄色葡萄球菌感染率方面被证明是有效的。
