Parras F, Rodríguez M, Bouza E, Muñoz P, Cercenado E, Guerrero C, Zancada G
Servicio de Microbiología Clínica, Hospital General Gregorio Marañón, Madrid.
Enferm Infecc Microbiol Clin. 1991 Apr;9(4):200-7.
The incidence of MRSA infections in Spain had remained in a low level through the years, being MRSA usually less than 1.5% of all S. aureus isolates. Since October 1988, we have detected in our hospital a MRSA outbreak. The epidemic started in the surgical wards, and spread through the rest of the institution. The incidence of cases was higher in the ICU's, areas that act as "multipliers" of the outbreak. In spite of standard control measures, the total number of patients with MRSA was 245 in April 1990. We studied prospectively a sample of 100 MRSA patients: thirty-six percent were colonized and 46% infected. The more common source of infection was the lower respiratory tract and primary bacteremia. The infection-related mortality was 30%. Our MRSA strain belong to phage type III, and shows a characteristic multiple antibiotic resistant pattern, the MRSA strain is sensitive to vancomycin, fusidic acid, phosphomycin and cotrimoxazole. Over the entire outbreak period, the MRSA strain developed resistance to rifampin, imipenem-cilastatin and ciprofloxacin. In spite of all control measures implemented, the outbreak can not have been totally controlled, and MRSA is now an endemic pathogen in our institution. Therefore, major changes in therapeutic approach to nosocomial infections have been since then introduced.
多年来，西班牙耐甲氧西林金黄色葡萄球菌（MRSA）感染的发生率一直处于较低水平，MRSA通常占所有金黄色葡萄球菌分离株的比例不到1.5%。自1988年10月以来，我们医院发现了一起MRSA暴发。疫情始于外科病房，并蔓延至医院的其他科室。重症监护病房（ICU）的病例发生率较高，这些区域成为了疫情的“倍增器”。尽管采取了标准的控制措施，但到1990年4月，MRSA患者的总数仍达到245例。我们对100例MRSA患者进行了前瞻性研究：36%为定植，46%为感染。最常见的感染源是下呼吸道和原发性菌血症。感染相关死亡率为30%。我们的MRSA菌株属于噬菌体III型，呈现出特征性的多重耐药模式，该MRSA菌株对万古霉素、夫西地酸、磷霉素和复方新诺明敏感。在整个暴发期间，MRSA菌株对利福平、亚胺培南 - 西司他丁和环丙沙星产生了耐药性。尽管实施了所有控制措施，但疫情仍未能得到完全控制，MRSA现在已成为我们医院的一种地方性病原菌。因此，从那时起，医院感染的治疗方法发生了重大变化。
