Nixon M, Jackson B, Varghese P, Jenkins D, Taylor G
Department of Orthopaedics, Glenfield Hospital, Leicester LE3 9QP, UK.
J Bone Joint Surg Br. 2006 Jun;88(6):812-7. doi: 10.1302/0301-620X.88B6.17544.
We examined the rates of infection and colonisation by methicillin-resistant Staphylococcus aureus (MRSA) between January 2003 and May 2004 in order to assess the impact of the introduction of an MRSA policy in October 2003, which required all admissions to be screened. Emergency admissions were treated prophylactically and elective beds ring-fenced. A total of 5,594 admissions were cross-referenced with 22,810 microbiology results. The morbidity, mortality and cost of managing MRSA-carrying patients, with a proximal fracture of the femur were compared, in relation to age, gender, American Society of Anaesthesiologists grade and residential status, with a group of matched controls who were MRSA-negative. In 2004, we screened 1795 of 1,796 elective admissions and MRSA was found in 23 (1.3%). We also screened 1,122 of 1,447 trauma admissions and 43 (3.8%) were carrying MRSA. All ten ward transfers were screened and four (40%) were carriers (all p < 0.001). The incidence of MRSA in trauma patients increased by 2.6% per week of inpatient stay (r = 0.97, p < 0.001). MRSA developed in 2.9% of trauma and 0.2% of elective patients during that admission (p < 0.001). The implementation of the MRSA policy reduced the incidence of MRSA infection by 56% in trauma patients (1.57% in 2003 (17 of 1,084) to 0.69% in 2004 (10 of 1,447), p = 0.035). Infection with MRSA in elective patients was reduced by 70% (0.56% in 2003 (7 of 1,257) to 0.17% in 2004 (3 of 1,806), p = 0.06). The cost of preventing one MRSA infection was 3,200 pounds. Although colonisation by MRSA did not affect the mortality rate, infection by MRSA more than doubled it. Patients with proximal fractures of the femur infected with MRSA remained in hospital for 50 extra days, had 19 more days of vancomycin treatment and 26 more days of vacuum-assisted closure therapy than the matched controls. These additional costs equated to 13,972 pounds per patient. From this experience we have been able to describe the epidemiology of MRSA, assess the impact of infection-control measures on MRSA infection rates and determine the morbidity, mortality and economic cost of MRSA carriage on trauma and elective orthopaedic wards.
我们调查了2003年1月至2004年5月期间耐甲氧西林金黄色葡萄球菌（MRSA）的感染率和定植率，以评估2003年10月实施的MRSA政策的影响，该政策要求对所有入院患者进行筛查。急诊入院患者接受预防性治疗，择期病床进行隔离。共对5594例入院患者与22810份微生物检测结果进行了交叉比对。将股骨近端骨折且携带MRSA患者的发病率、死亡率和管理成本，与年龄、性别、美国麻醉医师协会分级和居住状况相匹配的MRSA阴性对照组进行比较。2004年，我们对1796例择期入院患者中的1795例进行了筛查，发现23例（1.3%）携带MRSA。我们还对1447例创伤入院患者中的1122例进行了筛查，43例（3.8%）携带MRSA。对所有10例病房转科患者都进行了筛查，4例（40%）为携带者（所有p<0.001）。创伤患者中MRSA的发病率每住院一周增加2.6%（r=0.97，p<0.001）。在该次住院期间，2.9%的创伤患者和0.2%的择期患者发生了MRSA感染（p<0.001）。MRSA政策的实施使创伤患者的MRSA感染率降低了56%（2003年为1.57%（1084例中的17例），2004年为0.69%（1447例中的10例），p=0.035）。择期患者的MRSA感染率降低了70%（2003年为0.56%（1257例中的7例）至2004年的0.17%（1806例中的3例），p=0.06）。预防一例MRSA感染的成本为3200英镑。虽然MRSA定植未影响死亡率，但MRSA感染使其增加了一倍多。股骨近端骨折且感染MRSA的患者比匹配对照组多住院50天，多接受19天的万古霉素治疗和26天的负压封闭引流治疗。这些额外费用相当于每位患者13972英镑。通过这次经验，我们得以描述MRSA的流行病学特征，评估感染控制措施对MRSA感染率的影响，并确定MRSA定植在创伤和择期骨科病房的发病率、死亡率和经济成本。
