Ridenour Glenn A, Wong Edward S, Call Mark A, Climo Michael W
Division of Infectious Disease, Hunter Holmes McGuire Veteran Affairs Medical Center, Richmond, 23249, USA.
Infect Control Hosp Epidemiol. 2006 Mar;27(3):271-8. doi: 10.1086/500649. Epub 2006 Feb 28.
To determine the duration of methicillin-resistant Staphylococcus aureus (MRSA) colonization or infection before entry and during hospitalization in the intensive care unit (ICU) and the characteristics of patients who tested positive for MRSA.
Prospective observational cohort survey.
A combined medical and coronary care ICU with 16 single-bed rooms in a 427-bed tertiary care Veteran Affairs Medical Center.
A total of 720 ICU patients associated with 845 ICU admissions were followed up for the detection of MRSA from January 13, 2003, to October 12, 2003. MRSA colonization was detected in patients by using active surveillance cultures (ASCs) of nasal swab specimens obtained within 48 hours of ICU entry and 3 times weekly thereafter. The duration of colonization during ICU stay and before ICU entry was calculated after a review of surveillance culture results, clinical culture results, and medical history.
Ninety-three (11.0%) of 845 ICU admissions involved patients who were colonized with MRSA at the time of ICU entry, and 21 admissions (2.5%) involved patients who acquired MRSA during ICU stay. ASCs were positive for MRSA in 84 (73.6%) of the 114 admissions associated with MRSA positivity and were the sole means of identifying MRSA in 50 cases (43.8%). More than half of the MRSA-associated admissions involved patients who were transferred from hospital wards. The total bed-days of care for 38 admissions involving patients who tested positive for MRSA before ICU entry (1131 days) was nearly 20% higher than the total bed-days of care for all admissions associated with MRSA positivity (970 days). Admissions involving MRSA-positive patients were associated with a longer length of hospitalization before ICU entry (P < .001), longer length of ICU stay (P < .001), longer overall length of hospitalization (P < .001), and greater inpatient mortality than admissions involving MRSA-negative patients (P < .001). A total of 22.8% of all bed-care days were dedicated to MRSA-positive patients in the ICU, and 55 (48.2%) of 114 admissions associated with MRSA positivity involved patients who were colonized for the duration of their ICU stay.
In our unit, ASCs were an effective means to identify MRSA colonization among patients admitted to the ICU. Unfortunately, the majority of identified patients had long durations of stay in our own hospital before ICU entry, with prolonged MRSA colonization. Enhanced efforts to control MRSA will have to account for the prevalence of MRSA within hospital wards and to direct control efforts at these patients in the future.
确定重症监护病房（ICU）入院前及住院期间耐甲氧西林金黄色葡萄球菌（MRSA）定植或感染的持续时间，以及MRSA检测呈阳性患者的特征。
前瞻性观察队列研究。
一家拥有427张床位的三级医疗退伍军人事务医疗中心的综合内科和冠心病监护病房，设有16间单人病房。
2003年1月13日至2003年10月12日，对720例与845次ICU入院相关的患者进行随访，以检测MRSA。通过对ICU入院后48小时内及之后每周3次采集的鼻拭子标本进行主动监测培养（ASC）来检测患者的MRSA定植情况。在回顾监测培养结果、临床培养结果和病史后，计算ICU住院期间及ICU入院前的定植持续时间。
845次ICU入院中有93例（11.0%）患者在ICU入院时已被MRSA定植，21例（2.5%）入院患者在ICU住院期间获得了MRSA感染。在与MRSA阳性相关的114次入院中，84例（73.6%）的ASC检测MRSA呈阳性，其中50例（43.8%）是识别MRSA的唯一手段。超过一半与MRSA相关的入院患者是从医院病房转来的。38例ICU入院前MRSA检测呈阳性患者的总护理天数（1131天）比所有与MRSA阳性相关入院患者的总护理天数（970天）高出近20%。与MRSA阳性患者相关的入院与ICU入院前更长的住院时间（P <.001）、更长的ICU住院时间（P <.001）、更长的总体住院时间（P <.001）以及比MRSA阴性患者相关入院更高的住院死亡率相关（P <.001）。ICU中所有护理天数的22.8%用于MRSA阳性患者，在与MRSA阳性相关的114次入院中，55例（48.2%）患者在ICU住院期间一直处于定植状态。
在我们科室，ASC是识别ICU入院患者中MRSA定植的有效手段。不幸的是，大多数确诊患者在进入ICU之前在我院的住院时间较长，且MRSA定植时间延长。未来加强控制MRSA的努力必须考虑医院病房内MRSA的流行情况，并针对这些患者进行控制。
