Patel Mukesh, Weinheimer Jeffrey D, Waites Ken B, Baddley John W
Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA.
Infect Control Hosp Epidemiol. 2008 Jun;29(6):503-9. doi: 10.1086/588161.
The impact of methicillin-resistant Staphylococcus aureus (MRSA) colonization on mortality has not been well characterized. We sought to describe the impact of MRSA colonization on patients admitted to intensive care units (ICUs) in the Birmingham Veterans Affairs Medical Center (VAMC).
We conducted a retrospective cohort study of ICU patients at the Birmingham VAMC during 2005 to evaluate the predictors of MRSA colonization and determine its effect on clinical outcomes. Surveillance cultures for MRSA were performed on admission to the ICU and weekly thereafter. Clinical findings, the incidence of MRSA infection, and mortality within 3 months after ICU admission were recorded. Predictors of mortality and S. aureus colonization were determined using multivariable models.
S. aureus colonization was present in 97 (23.3%) of 416 patients screened, of whom 67 (16.1%) were colonized with methicillin-susceptible S. aureus (MSSA) and 30 (7.2%) with MRSA. All-cause mortality at 3 months among MRSA-colonized patients was significantly greater than that among MSSA-colonized patients (46.7% vs 19.4%; P = .009). MRSA colonization was an independent predictor of death (adjusted odds ratio [OR], 3.7 [95% confidence interval [CI], 1.5-8.9]; P = .003) and onset of MRSA infection after hospital discharge (adjusted OR, 7.6 [95% CI, 2.48-23.2]; P < .001). Risk factors for MRSA colonization included recent antibiotic use (adjusted OR, 4.8 [95% CI, 1.9-12.2]; P = .001) and dialysis (adjusted OR, 18.9 [95% CI, 2.1-167.8]; P = .008).
Among ICU patients, MRSA colonization is associated with subsequent MRSA infection and an all-cause mortality that is greater than that for MSSA colonization. Active surveillance for MRSA colonization may identify individuals at risk for these adverse outcomes. Prospective studies of outcomes in MRSA-colonized patients may better define the role of programs for active MRSA surveillance.
耐甲氧西林金黄色葡萄球菌（MRSA）定植对死亡率的影响尚未得到充分描述。我们试图描述MRSA定植对伯明翰退伍军人事务医疗中心（VAMC）重症监护病房（ICU）收治患者的影响。
我们对2005年期间伯明翰VAMC的ICU患者进行了一项回顾性队列研究，以评估MRSA定植的预测因素并确定其对临床结局的影响。在入住ICU时及之后每周进行MRSA的监测培养。记录临床发现、MRSA感染的发生率以及ICU入院后3个月内的死亡率。使用多变量模型确定死亡率和金黄色葡萄球菌定植的预测因素。
在416例接受筛查的患者中，有97例（23.3%）存在金黄色葡萄球菌定植，其中67例（16.1%）为甲氧西林敏感金黄色葡萄球菌（MSSA）定植，30例（7.2%）为MRSA定植。MRSA定植患者3个月时的全因死亡率显著高于MSSA定植患者（46.7%对19.4%；P = 0.009）。MRSA定植是死亡（校正比值比[OR]，3.7[95%置信区间[CI]，1.5 - 8.9]；P = 0.003）和出院后发生MRSA感染（校正OR，7.6[95% CI，2.48 - 23.2]；P < 0.001）的独立预测因素。MRSA定植的危险因素包括近期使用抗生素（校正OR，4.8[95% CI，1.9 - 12.2]；P = 0.001）和透析（校正OR，18.9[95% CI，2.1 - 167.8]；P = 0.008）。
在ICU患者中，MRSA定植与随后的MRSA感染以及高于MSSA定植的全因死亡率相关。对MRSA定植进行主动监测可能识别出发生这些不良结局的高危个体。对MRSA定植患者结局的前瞻性研究可能会更好地界定主动MRSA监测项目的作用。
