Cunningham R, Jenks P, Northwood J, Wallis M, Ferguson S, Hunt S
Department of Microbiology and Infection Control, Derriford Hospital, Plymouth, UK.
J Hosp Infect. 2007 Jan;65(1):24-8. doi: 10.1016/j.jhin.2006.09.019. Epub 2006 Dec 4.
We report a significant reduction in the rate of meticillin-resistant Staphylococcus aureus (MRSA) transmission on a critical care unit when admission screening by culture was replaced with a same-day polymerase chain reaction (PCR) test. This was an observational cohort study, set in a 19-bed mixed medical and surgical adult critical care unit in southwest England. We studied 1305 patients admitted between April 2005 and February 2006. Standard MRSA culture methods were used to screen 612 patients between April 2005 and August 2005, and the IDI MRSA PCR test was used to screen 693 patients between September 2005 and February 2006. Standard infection control precautions were instituted when positive results were obtained by either method. Outcome measures included carriage rate, turnaround time for results and rate of subsequent MRSA transmission on the unit. The overall carriage rate on admission to the unit was 7.0%. Culture results were available in three working days, PCR results within one working day. The mean incidence of MRSA transmission was 13.89/1000 patient days during the culture phase and 4.9/1000 patient days during the PCR phase (relative risk reduction 0.65, 95% CI 0.28-1.07). PCR screening for MRSA on admission to critical care units is feasible in routine clinical practice, provides quicker results than culture-based screening and is associated with a significant reduction in subsequent MRSA transmission.
我们报告称，在重症监护病房，当用当日聚合酶链反应（PCR）检测取代培养法进行入院筛查时，耐甲氧西林金黄色葡萄球菌（MRSA）的传播率显著降低。这是一项观察性队列研究，在英格兰西南部一个拥有19张床位的成人内外科混合重症监护病房进行。我们研究了2005年4月至2006年2月期间入院的1305例患者。2005年4月至2005年8月期间，采用标准的MRSA培养方法对612例患者进行筛查，2005年9月至2006年2月期间，采用IDI MRSA PCR检测对693例患者进行筛查。无论采用哪种方法获得阳性结果，均采取标准的感染控制预防措施。结果指标包括携带率、结果周转时间以及该病房随后的MRSA传播率。该病房入院时的总体携带率为7.0%。培养结果在三个工作日内可得，PCR结果在一个工作日内可得。在培养阶段，MRSA传播的平均发生率为13.89/1000患者日，在PCR阶段为4.9/1000患者日（相对风险降低0.65，95%可信区间0.28 - 1.07）。在重症监护病房入院时采用PCR筛查MRSA在常规临床实践中是可行的，比基于培养的筛查提供更快的结果，并且与随后MRSA传播的显著减少相关。
