Meyer Elisabeth, Schwab Frank, Gastmeier Petra, Jonas Daniel, Rueden Henning, Daschner Franz D
Institute of Environmental Medicine and Hospital Epidemiology, Freiburg University Hospital, Hugstetter Str. 55, 79106 Freiburg, Germany.
Infect Control Hosp Epidemiol. 2006 Feb;27(2):146-54. doi: 10.1086/500619. Epub 2006 Feb 8.
The objective of this study was to analyze methicillin-resistant Staphylococcus aureus (MRSA) percentages (defined as the percentage of S. aureus isolates that are resistant to methicillin) and antimicrobial consumption in intensive care units (ICUs) participating in Project SARI (Surveillance of Antimicrobial Use and Antimicrobial Resistance in Intensive Care Units), to look for temporal changes in MRSA percentages and antimicrobial consumption in individual ICUs as an indicator of the impact of an active surveillance system, and to investigate the differences between ICUs with increased MRSA percentages versus those with decreased percentages during a period of 3 years (2001-2003).
This was a prospective, ICU-based and laboratory-based surveillance study involving 38 German ICUs during 2000-2003. Antimicrobial use was reported in terms of defined daily doses (DDDs) per 1,000 patient-days. Temporal changes in the MRSA percentage and antimicrobial use in individual ICUs were calculated by means of the Wilcoxon signed rank test. The incidence density of nosocomial MRSA infection was defined as the number of nosocomial MRSA infections per 1,000 patient-days.
From February 2000 through December 2003, a total of 38 ICUs reported data on 499,694 patient-days and 9,552 S. aureus isolates, including 2,249 MRSA isolates and 660,029 DDDs of antimicrobials. Cumulative MRSA percentages ranged from 0% to 64.4%, with a mean of 23.6%. The MRSA incidence density ranged from 0 to 38.2 isolates per 1,000 patient-days, with a mean of 2.77 isolates per 1,000 patient-days. There was a positive correlation between MRSA percentage and imipenem and ciprofloxacin use (P<.05). Overall, comparison of data from 2001 with data from 2003 showed that MRSA percentages increased in 18 ICUs (median increase, 13.2% [range, 1.6%-38.4%]) and decreased in 14 ICUs (median decrease, 12% [range, 1.0%-48.4%]). Increased use of third-generation cephalosporins, glycopeptides, or aminoglycosides correlated significantly with an increase in the MRSA percentage (P<.05). The cumulative nosocomial MRSA infection incidence density for 141 ICUs that did not participate in SARI and, therefore, did not receive feedback increased from 0.26 to 0.35 infections per 1,000 patient-days during a 3-year period, whereas the rate in SARI ICUs decreased from 0.63 to 0.40 infections per 1,000 patient-days.
The MRSA situation in German ICUs is still heterogeneous. Because MRSA percentages range from 0% to 64.4%, further studies are required to confirm findings that no change in the MRSA percentage and a decrease in the nosocomial MRSA infection incidence density in SARI ICUs reflect the impact of an active surveillance system.
本研究的目的是分析参与SARI项目（重症监护病房抗菌药物使用与抗菌药物耐药性监测）的重症监护病房（ICU）中耐甲氧西林金黄色葡萄球菌（MRSA）的百分比（定义为对甲氧西林耐药的金黄色葡萄球菌分离株的百分比）和抗菌药物消耗情况，寻找单个ICU中MRSA百分比和抗菌药物消耗的时间变化，以此作为主动监测系统影响的指标，并调查在3年期间（2001 - 2003年）MRSA百分比增加的ICU与MRSA百分比降低的ICU之间的差异。
这是一项基于ICU和实验室的前瞻性监测研究，在2000 - 2003年期间涉及38个德国ICU。抗菌药物使用情况以每1000个患者日的限定日剂量（DDD）来报告。通过Wilcoxon符号秩检验计算单个ICU中MRSA百分比和抗菌药物使用的时间变化。医院获得性MRSA感染的发病密度定义为每1000个患者日的医院获得性MRSA感染病例数。
从2000年2月到2003年12月，共有38个ICU报告了499,694个患者日的数据以及9552株金黄色葡萄球菌分离株，其中包括2249株MRSA分离株和660,029个DDD的抗菌药物。MRSA累积百分比范围从0%到64.4%，平均为23.6%。MRSA发病密度范围为每1000个患者日0至38.2株，平均为每1000个患者日2.77株。MRSA百分比与亚胺培南和环丙沙星的使用之间存在正相关（P <.05）。总体而言，将2001年的数据与2003年的数据进行比较，发现18个ICU的MRSA百分比增加（中位数增加，13.2% [范围，1.6% - 38.4%]），14个ICU的MRSA百分比降低（中位数降低，12% [范围，1.0% - 48.4%]）。第三代头孢菌素、糖肽类或氨基糖苷类药物使用的增加与MRSA百分比的增加显著相关（P <.05）。141个未参与SARI项目且因此未收到反馈信息的ICU的医院获得性MRSA感染累积发病密度在3年期间从每1000个患者日0.26例增加到0.35例，而参与SARI项目的ICU的感染率从每1000个患者日0.63例降至0.40例。
德国ICU中的MRSA情况仍然存在异质性。由于MRSA百分比范围从0%到64.4%，需要进一步研究以证实SARI项目ICU中MRSA百分比无变化以及医院获得性MRSA感染发病密度降低反映了主动监测系统的影响这一发现。
