Pfaller M A, Wakefield D S, Hollis R, Fredrickson M, Evans E, Massanari R M
Veterans Affairs Medical Center, Iowa City, Iowa.
Diagn Microbiol Infect Dis. 1991 May-Jun;14(3):209-17. doi: 10.1016/0732-8893(91)90034-d.
A microbiologic surveillance study was performed in order to estimate the point prevalence, source, and nosocomial acquisition of methicillin-resistant Staphylococcus aureus (MRSA) within the Iowa City Veterans Affairs Medical Center (IC VAMC). Immediately following the microbiologic surveillance study, a cluster of nosocomial MRSA infections was detected by routine infection control surveillance. An epidemiologic investigation was conducted and all isolates of MRSA detected during the microbiologic surveillance study and the subsequent cluster of nosocomial infections were characterized by restriction endonuclease analysis of plasmid DNA (REAP). REAP subtyping defined a total of ten distinct subtypes from 24 patients infected or colonized with MRSA. The documentation of a single subtype of MRSA (subtype A2) in nine patients from the surgical service, eight of which were hospitalized in the surgical intensive care unit, provided convincing evidence of a breakdown of infection control practices in that unit. REAP subtyping was a highly discriminating means of identifying different subtypes among the various isolates of MRSA and was useful in directing infection control efforts to specific problem areas within the hospital. Molecular typing methods, such as REAP, when used appropriately in conjunction with careful epidemiologic investigation provide an effective approach to the investigation and control of the spread of MRSA within the hospital.
为了估计爱荷华市退伍军人事务医疗中心（IC VAMC）内耐甲氧西林金黄色葡萄球菌（MRSA）的现患率、来源及医院获得情况，开展了一项微生物监测研究。在微生物监测研究之后，通过常规感染控制监测立即发现了一批医院内MRSA感染病例。进行了一项流行病学调查，并通过质粒DNA的限制性内切酶分析（REAP）对微生物监测研究期间及随后医院感染群中检测到的所有MRSA分离株进行了特征分析。REAP分型从24例感染或定植MRSA的患者中确定了总共10种不同的亚型。外科科室的9名患者中发现单一亚型的MRSA（A2亚型），其中8人入住外科重症监护病房，这为该科室感染控制措施的失效提供了有力证据。REAP分型是一种高度区分性的方法，可用于识别MRSA不同分离株中的不同亚型，有助于将感染控制工作指向医院内特定的问题区域。分子分型方法，如REAP，与细致的流行病学调查相结合时，可为医院内MRSA传播的调查与控制提供一种有效的方法。
