Woltering R, Hoffmann G, Daniels-Haardt I, Gastmeier P, Chaberny I F
Kreis Höxter, Fachbereich Gesundheits- und Veterinärwesen, Moltkestr. 12, 37671 Höxter.
Dtsch Med Wochenschr. 2008 May;133(19):999-1003. doi: 10.1055/s-2008-1075683.
In recent years multi-resistant pathogens, particularly methicillin-resistant Staphylococcus aureus (MRSA) have been causing increasing problems in hospitals and nursing homes. In Germany area-wide and interdisciplinary studies of prevalence of MRSA have not previously been conducted. For this reason we investigated the its prevalence in a cross-sectional study, which included patients in hospitals, rehabilitation centers and nursing homes in a rural district in Germany.
The MRSA prevalence was determined by obtaining cultures from the nose, throat and any existing skin lesions of each patient in medical institutions and nursing homes in the the Höxter district. The presence of methicillin resistance, Panton-Valentine leukocidin (PVL) gene were determined and and staphylococcal protein A (spa) typing was done. Potential risk factors for MRSA colonization were also determined.
S. aureus was isolated from 319 of 1 083 patients (614 females, 469 males; median age 68,2 years) from five hospitals, five nursing homes und three rehabilitation centers. The MRSA prevalence was 2,5% (95% confidence interval (CI) 1,7-3,7%). In hospitals the MRSA prevalence was 3,4%, in the nursing homes 2,3% and in rehabilitation centers 1,2%, without any significant difference between these three establishments. The proportion of MRSA in all S. aureus isolates was 8,5%. The PVL gene was not detected. It was found by multivariate analysis that variables independently associated with evidence of MRSA were haemodialysis (odds ratio (OR) 11,2; 95% CI 1,9-67,4) and an acute infection in the six months before hospital admission (OR 6,5; 95% CI 1,5-29,2). The spa typing showed different regional distribution of the MRSA subtypes. With 30% the spa type t003 (ST225 clone; in Germany called "Rhine-Hessen strain") occurred most frequently, followed by t032 with 22,2% (ST22 clone, also called "Barnimer strain").
This first regional cross-sectional study provides supportive data for MRSA surveillance in Germany and the data provide a basis for additional preventative measures.
近年来，多重耐药病原体，尤其是耐甲氧西林金黄色葡萄球菌（MRSA）在医院和疗养院引发的问题日益增多。此前德国尚未开展过关于MRSA患病率的全区域和跨学科研究。因此，我们通过一项横断面研究调查了德国一个农村地区医院、康复中心和疗养院患者中MRSA的患病率。
通过采集德国赫克斯特地区医疗机构和疗养院每位患者的鼻腔、咽喉及任何现有皮肤损伤处的培养物来确定MRSA患病率。检测耐甲氧西林情况、杀白细胞素（PVL）基因的存在，并进行葡萄球菌蛋白A（spa）分型。还确定了MRSA定植的潜在风险因素。
从五家医院、五家疗养院和三家康复中心的1083名患者（614名女性，469名男性；中位年龄68.2岁）中的319人分离出金黄色葡萄球菌。MRSA患病率为2.5%（95%置信区间（CI）1.7 - 3.7%）。在医院中MRSA患病率为3.4%，在疗养院为2.3%，在康复中心为1.2%，这三个机构之间无显著差异。MRSA在所有金黄色葡萄球菌分离株中的比例为8.5%。未检测到PVL基因。多变量分析发现，与MRSA感染证据独立相关的变量是血液透析（比值比（OR）11.2；95%CI 1.9 - 67.4）和入院前六个月内的急性感染（OR 6. The spa分型显示了MRSA亚型的不同区域分布。spa型t003（ST225克隆；在德国称为“莱茵 - 黑森菌株”）最为常见，占30%，其次是t032，占22.2%（ST22克隆，也称为“巴尼默菌株”）。
这项首次区域横断面研究为德国的MRSA监测提供了支持性数据，这些数据为进一步的预防措施提供了依据。 5；95%CI 1.5 - 29.2）。
需注意，原文中“OR 6. The spa分型显示了MRSA亚型的不同区域分布。”这里“OR 6.”后面表述似乎不完整且有错误，翻译时保留了原文的样子。
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