Robicsek Ari, Beaumont Jennifer L, Paule Suzanne M, Hacek Donna M, Thomson Richard B, Kaul Karen L, King Peggy, Peterson Lance R
Evanston Northwestern Healthcare and Northwestern University Feinberg School of Medicine, Evanston, Illinois 60201, USA.
Ann Intern Med. 2008 Mar 18;148(6):409-18. doi: 10.7326/0003-4819-148-6-200803180-00003.
The effect of large-scale expanded surveillance for methicillin-resistant Staphylococcus aureus (MRSA) on health care-associated MRSA disease is not known.
To examine the effect of 2 expanded surveillance interventions on MRSA disease.
Observational study comparing rates of MRSA clinical disease during and after hospital admission in 3 consecutive periods: baseline (12 months), MRSA surveillance for all admissions to the intensive care unit (ICU) (12 months), and universal MRSA surveillance for all hospital admissions (21 months).
A 3-hospital, 850-bed organization with approximately 40,000 annual admissions.
Polymerase chain reaction-based nasal surveillance for MRSA followed by topical decolonization therapy and contact isolation of patients who tested positive for MRSA.
Poisson and segmented regression models were used to compare prevalence density of hospital-associated clinical MRSA disease (bloodstream, respiratory, urinary tract, and surgical site) in each period. Rates of bloodstream disease with methicillin-susceptible S. aureus were used as a control.
The prevalence density of aggregate hospital-associated MRSA disease (all body sites) per 10,000 patient-days at baseline, during ICU surveillance, and during universal surveillance was 8.9 (95% CI, 7.6 to 10.4), 7.4 (CI, 6.1 to 9.0; P = 0.15 compared with baseline), and 3.9 (CI, 3.2 to 4.7; P < 0.001 compared with baseline and ICU surveillance), respectively. During universal surveillance, the prevalence density of MRSA infection at each body site had a statistically significant decrease compared with baseline. The methicillin-susceptible S. aureus bacteremia rate did not statistically significantly change during the 3 periods. In a segmented regression model, the aggregate hospital-associated MRSA disease prevalence density changed by -36.2% (CI, -65.4% to 9.8%; P = 0.17) from baseline to ICU surveillance and by -69.6% (CI, -89.2% to -19.6%]; P = 0.03) from baseline to universal surveillance. During universal surveillance, the MRSA disease rate decreased during hospitalization and in the 30 days after discharge; no further reduction occurred thereafter. Surveillance with clinical cultures would have identified 17.8% of actual MRSA patient-days, and ICU-based surveillance with polymerase chain reaction would have identified 33.3%.
The findings rely on observational data.
The introduction of universal admission surveillance for MRSA was associated with a large reduction in MRSA disease during admission and 30 days after discharge.
耐甲氧西林金黄色葡萄球菌（MRSA）大规模扩大监测对医疗相关MRSA疾病的影响尚不清楚。
研究两种扩大监测干预措施对MRSA疾病的影响。
观察性研究，比较连续3个时期住院期间及出院后MRSA临床疾病发生率：基线期（12个月）、对重症监护病房（ICU）所有入院患者进行MRSA监测（12个月）、对所有住院患者进行全面MRSA监测（21个月）。
一家拥有3所医院、850张床位、年入院患者约40000例的医疗机构。
基于聚合酶链反应的鼻腔MRSA监测，随后进行局部去定植治疗，并对MRSA检测呈阳性的患者进行接触隔离。
采用泊松和分段回归模型比较各时期医院相关临床MRSA疾病（血流、呼吸道、泌尿道和手术部位）的患病率密度。以甲氧西林敏感金黄色葡萄球菌血流疾病发生率作为对照。
基线期、ICU监测期和全面监测期每10000患者日医院相关MRSA疾病（所有身体部位）的患病率密度分别为8.9（95%CI，7.6至10.4）、7.4（CI，6.1至9.0；与基线期相比，P = 0.15）和3.9（CI，3.2至4.7；与基线期和ICU监测期相比，P < 0.001）。在全面监测期，与基线期相比，各身体部位MRSA感染的患病率密度均有统计学显著下降。甲氧西林敏感金黄色葡萄球菌菌血症发生率在这3个时期无统计学显著变化。在分段回归模型中，医院相关MRSA疾病总体患病率密度从基线期到ICU监测期变化了-36.2%（CI，-65.4%至9.8%；P = 0.1
