Larue Alexandrine, Loos-Ayav Carole, Jay Nicolas, Commun Nathalie, Rabaud Christian, Bollaert Pierre-Edouard
Service de médecine interne, Centre hospitalier Jean Monnet, F-88000 Epinal, France.
Presse Med. 2009 Jan;38(1):25-33. doi: 10.1016/j.lpm.2008.06.005. Epub 2008 Sep 3.
Prevention of methicillin-resistant Staphylococcus aureus (MRSA) nosocomial infections in the intensive care units (ICU) has been recommended for several years. However, the workload and the costs of these programs are to be weighed against the benefit obtained in terms of reduction of morbidity and costs induced by the infection. The purpose of this study was to evaluate the cost and the current morbidity of the infection with MRSA in the ICU.
In a retrospective case-control study carried out in 2004, all patients of the 6 intensive care units of a teaching hospital having developed a MRSA nosocomial infection were included. They were paired with controls on the following criteria: department, Simplified Acute Physiology Score II (SAPSII), age (+/- 5 years), type of surgery (for the surgical intensive care units). The duration of hospitalization of the paired control had to be at least equal to the time from admission to infection of the infected patient. The costs were evaluated using the following parameters: scores omega 1, 2 and 3, duration of artificial ventilation, hemodialysis, length of ICU stay, radiological procedures, surgical procedures, total antibiotic cost and other expensive drugs.
Twenty-one patients with MRSA infection were included. All had nosocomial pneumonia. The 21 paired patients were similar with regard to both initial criteria and sex. Hospital mortality was not different between the 2 groups (cases=8; controls=6; p=0.41), as well as median duration of hospital stay (cases=41 days; controls=43 days; p=0.9). The duration of mechanical ventilation, number of hemodialysis or hemofiltration sessions, number of radiological procedures were similar in both groups. The total omega score was not significantly different between cases (median 435; IQR: 218-579) and controls (median 281, IQR: 231-419; p=0.55). The median duration of isolation was 12 days for cases and 0 day for controls (p=0.0007). The pharmaceutical expenditure was significantly higher in cases (median: 1414euro; IQR: 795-4349), by comparison with the controls (median: 877euro, IQR: 687-2496) (p=0.049).
In the ICU having set up a policy intended to reduce the risk of MRSA nosocomial infections, MRSA pneumonia does not seem to involve major additional morbidity, as compared to a control population matched for similar severity of illness. It increases modestly the use of the medical resources.
数年来一直建议在重症监护病房（ICU）预防耐甲氧西林金黄色葡萄球菌（MRSA）医院感染。然而，这些项目的工作量和成本需要与感染导致的发病率降低和成本节约所带来的益处相权衡。本研究的目的是评估ICU中MRSA感染的成本和当前发病率。
在一项2004年进行的回顾性病例对照研究中，纳入了一家教学医院6个重症监护病房中所有发生MRSA医院感染的患者。根据以下标准为他们匹配对照：科室、简化急性生理学评分II（SAPSII）、年龄（±5岁）、手术类型（针对外科重症监护病房）。配对对照的住院时间必须至少等于感染患者从入院到感染的时间。使用以下参数评估成本：ω1、2和3评分、人工通气持续时间、血液透析、ICU住院时间、放射检查、外科手术、抗生素总费用和其他昂贵药物。
纳入了21例MRSA感染患者。所有患者均患有医院获得性肺炎。21对配对患者在初始标准和性别方面相似。两组的医院死亡率无差异（病例组=8例；对照组=6例；p=0.41），住院时间中位数也无差异（病例组=41天；对照组=43天；p=0.9）。两组的机械通气持续时间、血液透析或血液滤过次数、放射检查次数相似。病例组（中位数435；四分位数间距：218 - 579）和对照组（中位数281，四分位数间距：231 - 419；p=0.55）的总ω评分无显著差异。病例组的隔离中位数持续时间为12天，对照组为0天（p=0.0007）。与对照组（中位数：877欧元，四分位数间距：687 - 2496）相比，病例组的药物支出显著更高（中位数：1414欧元；四分位数间距：795 - 4349）（p=0.049）。
在已制定旨在降低MRSA医院感染风险政策的ICU中，与病情严重程度相似的对照人群相比，MRSA肺炎似乎不会带来重大的额外发病率。它适度增加了医疗资源的使用。
