Coombs G W, Van Gessel H, Pearson J C, Godsell M-R, O'Brien F G, Christiansen K J
Department of Microbiology and Infectious Diseases, PathWest Laboratory Medicine, Western ustralia, Royal Perth Hospital, Perth, Australia.
Infect Control Hosp Epidemiol. 2007 Jul;28(7):845-52. doi: 10.1086/518726. Epub 2007 Jun 5.
To describe the control of an outbreak of infection and colonization with the New York/Japan methicillin-resistant Staphylococcus aureus (MRSA) clone in multiple healthcare facilities, and to demonstrate the importance of making an MRSA management policy involving molecular typing of MRSA into a statewide public health responsibility.
A range of healthcare facilities, including 2 metropolitan teaching hospitals and a regional hospital, as well as several community hospitals and long-term care facilities in a nonmetropolitan healthcare region.
A comprehensive, statewide MRSA epidemiological investigation and management policy.
In May 2005, there were 3 isolates referred to the Western Australian Gram-Positive Bacteria Typing and Research Unit that were identified as the New York/Japan MRSA clone, a pandemic MRSA clone with the ability to spread and replace existing clones in a region. Subsequent investigation identified 28 additional cases of infection and/or colonization dating from 2002 onward, including 1 involving a colonized healthcare worker (HCW) who had previously been hospitalized overseas. Of the 31 isolates detected, 25 were linked epidemiologically and via molecular typing to the isolate recovered from the colonized HCW. Four isolates appeared to have been introduced separately from overseas. Although the isolate from the single remaining case patient was genetically indistinct from the isolates that spread within Western Australia, no specific epidemiological link could be established. The application of standard outbreak management strategies reduced further spread.
The elimination of the New/York Japan MRSA clone in a healthcare region demonstrates the importance of incorporating MRSA management policy into statewide public health programs. The mainstays of such programs should include a comprehensive and effective outbreak identification and management policy (including pre-employment screening of HCWs, where applicable) and MRSA clone identification by multilocus sequence typing.
描述在多个医疗机构中对纽约/日本耐甲氧西林金黄色葡萄球菌（MRSA）克隆感染和定植暴发的控制情况，并证明将涉及MRSA分子分型的MRSA管理政策纳入全州公共卫生职责的重要性。
一系列医疗机构，包括2家大都市教学医院和1家地区医院，以及非大都市医疗区域的几家社区医院和长期护理机构。
一项全面的全州MRSA流行病学调查和管理政策。
2005年5月，有3株菌株被送至西澳大利亚革兰氏阳性细菌分型与研究单位，被鉴定为纽约/日本MRSA克隆，这是一种具有在一个地区传播并取代现有克隆能力的大流行MRSA克隆。随后的调查发现了另外28例自2002年起的感染和/或定植病例，其中1例涉及一名曾在海外住院的定植医护人员（HCW）。在检测到的31株菌株中，25株在流行病学上以及通过分子分型与从定植HCW分离出的菌株相关联。4株菌株似乎是从海外分别引入的。尽管剩余单例病例患者的菌株在基因上与在西澳大利亚传播的菌株没有区别，但无法建立具体的流行病学联系。应用标准的暴发管理策略减少了进一步传播。
在一个医疗区域消除纽约/日本MRSA克隆证明了将MRSA管理政策纳入全州公共卫生项目的重要性。此类项目的主要支柱应包括全面有效的暴发识别和管理政策（包括在适用情况下对医护人员进行入职前筛查）以及通过多位点序列分型鉴定MRSA克隆。
