Gener G, Dupuy A, Rouveau M, Claisse J-P, Casin I, Dubertret L, Morel P, Simon F, Viguier M
Service de dermatologie, université Paris-VII Denis-Diderot, hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris, 1, avenue Claude-Vellefaux, 75475 Paris cedex 10, France.
Ann Dermatol Venereol. 2008 Dec;135(12):815-21. doi: 10.1016/j.annder.2008.09.010. Epub 2008 Nov 11.
In a bid to combat methicillin-resistant Staphylococcus aureus (MRSA) more efficiently in our department, we performed a study to 1) clarify the MRSA carriage rate in patients hospitalized in the department; 2) evaluate the rate of MRSA acquisition during hospitalization; 3) describe the MRSA carrier profile; 4) study the morbidity and mortality associated with MRSA.
We conducted a three-month prospective study in all patients hospitalized for more than 24hours in the dermatology department of the Saint-Louis Hospital. Nasal swab cultures were performed on the day of admission, once a week thereafter and on the day of discharge. Clinical and epidemiological data were individually reviewed by means of a standardized questionnaire.
In 310 patients, the prevalence of nasal MRSA carriage at admission was 6.5%. During hospitalization, 1.9% of our patients became colonized with MRSA. MRSA carriers were significantly older than non-carriers and had been hospitalized more frequently over the previous 12 months, principally in intensive care or in intermediate or long-term care facilities, and erosive and/or ulcerated dermatitis was more common in this population. Of the 27 patients colonized with MRSA, only three had MRSA infections, and these were successfully treated with antibiotics.
The observed rate of MRSA carriage was close to that seen in intensive care units (7%). While systematic screening for MRSA in patients with erosive and/or ulcerated dermatitis would allow detection of twice as many cases of MRSA than the usual screening recommendations, this would be associated with little tangible benefit and high costs, and we therefore decided not to change the usual MRSA screening politic in our dermatology department.
为了在我们科室更有效地对抗耐甲氧西林金黄色葡萄球菌（MRSA），我们开展了一项研究，以：1）明确该科室住院患者的MRSA携带率；2）评估住院期间MRSA获得率；3）描述MRSA携带者特征；4）研究与MRSA相关的发病率和死亡率。
我们在圣路易医院皮肤科对所有住院超过24小时的患者进行了为期三个月的前瞻性研究。入院当天、此后每周一次以及出院当天进行鼻拭子培养。通过标准化问卷对临床和流行病学数据进行单独审查。
在310例患者中，入院时鼻MRSA携带率为6.5%。住院期间，1.9%的患者感染了MRSA。MRSA携带者明显比非携带者年龄大，且在过去12个月内住院次数更多，主要是在重症监护病房或中长期护理机构，并且糜烂性和/或溃疡性皮炎在该人群中更为常见。在27例感染MRSA的患者中，只有3例发生了MRSA感染，这些患者均通过抗生素成功治愈。
观察到的MRSA携带率与重症监护病房所见相近（7%）。虽然对患有糜烂性和/或溃疡性皮炎的患者进行MRSA系统筛查会比通常的筛查建议多发现两倍的MRSA病例，但这几乎没有实际益处且成本高昂，因此我们决定不改变我们皮肤科通常的MRSA筛查策略。
