Harbarth Stephan, Fankhauser Carolina, Schrenzel Jacques, Christenson Jan, Gervaz Pascal, Bandiera-Clerc Catherine, Renzi Gesuele, Vernaz Nathalie, Sax Hugo, Pittet Didier
Infection Control Program, University of Geneva Hospitals and Medical School, Geneva, Switzerland.
JAMA. 2008 Mar 12;299(10):1149-57. doi: 10.1001/jama.299.10.1149.
Experts and policy makers have repeatedly called for universal screening at hospital admission to reduce nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection.
To determine the effect of an early MRSA detection strategy on nosocomial MRSA infection rates in surgical patients.
DESIGN, SETTING, AND PATIENTS: Prospective, interventional cohort study conducted between July 2004 and May 2006 among 21 754 surgical patients at a Swiss teaching hospital using a crossover design to compare 2 MRSA control strategies (rapid screening on admission plus standard infection control measures vs standard infection control alone). Twelve surgical wards including different surgical specialties were enrolled according to a prespecified agenda, assigned to either the control or intervention group for a 9-month period, then switched over to the other group for a further 9 months.
During the rapid screening intervention periods, patients admitted to the intervention wards for more than 24 hours were screened before or on admission by rapid, multiplex polymerase chain reaction. For both intervention (n=10 844) and control (n=10 910) periods, standard infection control measures were used for patients with MRSA in all wards and consisted of contact isolation of MRSA carriers, use of dedicated material (eg, gown, gloves, mask if indicated), adjustment of perioperative antibiotic prophylaxis of MRSA carriers, computerized MRSA alert system, and topical decolonization (nasal mupirocin ointment and chlorhexidine body washing) for 5 days.
Incidence of nosocomial MRSA infection, MRSA surgical site infection, and rates of nosocomial acquisition of MRSA.
Overall, 10 193 of 10 844 patients (94%) were screened during the intervention periods. Screening identified 515 MRSA-positive patients (5.1%), including 337 previously unknown MRSA carriers. Median time from screening to notification of test results was 22.5 hours (interquartile range, 12.2-28.2 hours). In the intervention periods, 93 patients (1.11 per 1000 patient-days) developed nosocomial MRSA infection compared with 76 in the control periods (0.91 per 1000 patient-days; adjusted incidence rate ratio, 1.20; 95% confidence interval, 0.85-1.69; P = .29). The rate of MRSA surgical site infection and nosocomial MRSA acquisition did not change significantly. Fifty-three of 93 infected patients (57%) in the intervention wards were MRSA-free on admission and developed MRSA infection during hospitalization.
A universal, rapid MRSA admission screening strategy did not reduce nosocomial MRSA infection in a surgical department with endemic MRSA prevalence but relatively low rates of MRSA infection.
isrctn.org Identifier: ISRCTN06603006.
专家和政策制定者多次呼吁在医院入院时进行普遍筛查，以减少医院内耐甲氧西林金黄色葡萄球菌（MRSA）感染。
确定早期MRSA检测策略对外科手术患者医院内MRSA感染率的影响。
设计、地点和患者：2004年7月至2006年5月期间，在瑞士一家教学医院对21754名外科手术患者进行了前瞻性、干预性队列研究，采用交叉设计比较两种MRSA控制策略（入院时快速筛查加标准感染控制措施与仅采用标准感染控制措施）。根据预先确定的议程，纳入了包括不同外科专业的12个外科病房，将其分配到对照组或干预组，为期9个月，然后再切换到另一组，再持续9个月。
在快速筛查干预期间，入住干预病房超过24小时的患者在入院前或入院时通过快速多重聚合酶链反应进行筛查。在干预期（n = 10844）和对照期（n = 10910），所有病房对MRSA患者均采用标准感染控制措施，包括对MRSA携带者进行接触隔离、使用专用材料（如必要时的隔离衣、手套、口罩）、调整MRSA携带者围手术期抗生素预防措施、计算机化MRSA警报系统以及进行5天的局部去定植（鼻用莫匹罗星软膏和洗必泰全身清洗）。
医院内MRSA感染的发生率、MRSA手术部位感染以及医院内MRSA获得率。
总体而言，在干预期间，10844名患者中有10193名（94%）接受了筛查。筛查发现515名MRSA阳性患者（5.
