Chaberny Iris F, Bindseil A, Sohr D, Gastmeier P
Institute of Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
Infection. 2008 Dec;36(6):526-32. doi: 10.1007/s15010-008-7436-1. Epub 2008 Aug 25.
Due to the enormous increase in the number of MRSA-patients, in July 2004, an extended admission screening protocol was implemented in ICUs and surgical wards at Hannover Medical School.
In 2005, a point-prevalence study (also known as a cross-sectional study) was conducted to determine the prevalence of MRSA and Panton-Valentine leukocidin (PVL) among inpatients, to identify patients at risk for MRSA colonization and to evaluate compliance with admission screening. Inpatients were screened by taking cultures from nose, throat and skin lesions. S. aureus isolates were tested for antimicrobial susceptibility and PVL. MRSA was analyzed by staphylococcal protein A (spa) typing.
Of 509 inpatients, 145 (28%) were S. aureus carriers. 27 (19%) inpatients were MRSA positive, i.e., the MRSA point-prevalence was 5.3% (95% CI, 3.49; 7.70). spa type t032 was predominant in 67% of the MRSA inpatients. The PVL gene was present in one (0.2%) methicillin-susceptible strain. Comparison with data retrieved from the local hospital MRSA database showed that, the status of 37% of the MRSA had previously remained undetected (10/27). Consequently, MRSA colonization was newly identified in 2.0% (10/509) of the patients. Compliance with admission screening failed in three cases. Nosocomial acquisition was identified in three patients. Four other patients harbouring MRSA were newly identified on wards without routine screening (three neurological, one internal medicine ward).
Despite extended admission screening, 37% of all MRSA-positive inpatients were missed. The neurological patients were identified as a further risk group and were included in the admission screening procedure established.
由于耐甲氧西林金黄色葡萄球菌（MRSA）感染患者数量大幅增加，2004年7月，汉诺威医学院的重症监护病房（ICU）和外科病房实施了扩展的入院筛查方案。
2005年，开展了一项现患率研究（也称为横断面研究），以确定住院患者中MRSA和杀白细胞素（PVL）的现患率，识别有MRSA定植风险的患者，并评估入院筛查的依从性。通过采集患者鼻腔、咽喉和皮肤损伤处的培养物对住院患者进行筛查。对分离出的金黄色葡萄球菌进行药敏试验和PVL检测。采用葡萄球菌蛋白A（spa）分型对MRSA进行分析。
509例住院患者中，145例（28%）为金黄色葡萄球菌携带者。27例（19%）住院患者MRSA呈阳性，即MRSA现患率为5.3%（95%可信区间，3.49；7.70）。spa t032型在67%的MRSA阳性住院患者中占主导地位。PVL基因存在于一株（0.2%）甲氧西林敏感菌株中。与当地医院MRSA数据库检索的数据相比，37%的MRSA感染状态此前未被发现（27例中的10例）。因此，2.0%（10/509）的患者被新发现有MRSA定植。3例患者未遵守入院筛查要求。3例患者被确定为医院内感染。另外4例携带MRSA的患者是在未进行常规筛查的病房中被新发现的（3例在神经科病房，1例在内科病房）。
尽管实施了扩展的入院筛查，但仍有37%的MRSA阳性住院患者未被发现。神经科患者被确定为另一高风险群体，并被纳入已确立的入院筛查程序。
