Burton Deron C, Edwards Jonathan R, Horan Teresa C, Jernigan John A, Fridkin Scott K
Surveillance Branch, Division of Healthcare Quality Promotion, National Center for Preparedness, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
JAMA. 2009 Feb 18;301(7):727-36. doi: 10.1001/jama.2009.153.
Concerns about rates of methicillin-resistant Staphylococcus aureus (MRSA) health care-associated infections have prompted calls for mandatory screening or reporting in efforts to reduce MRSA infections.
To examine trends in the incidence of MRSA central line-associated bloodstream infections (BSIs) in US intensive care units (ICUs).
DESIGN, SETTING, AND PARTICIPANTS: Data reported by hospitals to the Centers for Disease Control and Prevention (CDC) from 1997-2007 were used to calculate pooled mean annual central line-associated BSI incidence rates for 7 types of adult and non-neonatal pediatric ICUs. Percent MRSA was defined as the proportion of S aureus central line-associated BSIs that were MRSA. We used regression modeling to estimate percent changes in central line-associated BSI metrics over the analysis period.
Incidence rate of central line-associated BSIs per 1000 central line days; percent MRSA among S. aureus central line-associated BSIs.
Overall, 33,587 central line-associated BSIs were reported from 1684 ICUs representing 16,225,498 patient-days of surveillance; 2498 reported central line-associated BSIs (7.4%) were MRSA and 1590 (4.7%) were methicillin-susceptible S. aureus (MSSA). Of evaluated ICU types, surgical, nonteaching-affiliated medical-surgical, cardiothoracic, and coronary units experienced increases in MRSA central line-associated BSI incidence in the 1997-2001 period; however, medical, teaching-affiliated medical-surgical, and pediatric units experienced no significant changes. From 2001 through 2007, MRSA central line-associated BSI incidence declined significantly in all ICU types except in pediatric units, for which incidence rates remained static. Declines in MRSA central line-associated BSI incidence ranged from -51.5% (95% CI, -33.7% to -64.6%; P < .001) in nonteaching-affiliated medical-surgical ICUs (0.31 vs 0.15 per 1000 central line days) to -69.2% (95% CI, -57.9% to -77.7%; P < .001) in surgical ICUs (0.58 vs 0.18 per 1000 central line days). In all ICU types, MSSA central line-associated BSI incidence declined from 1997 through 2007, with changes in incidence ranging from -60.1% (95% CI, -41.2% to -73.1%; P < .001) in surgical ICUs (0.24 vs 0.10 per 1000 central line days) to -77.7% (95% CI, -68.2% to -84.4%; P < .001) in medical ICUs (0.40 vs 0.09 per 1000 central line days). Although the overall proportion of S. aureus central line-associated BSIs due to MRSA increased 25.8% (P = .02) in the 1997-2007 period, overall MRSA central line-associated BSI incidence decreased 49.6% (P < .001) over this period.
The incidence of MRSA central line-associated BSI has been decreasing in recent years in most ICU types reporting to the CDC. These trends are not apparent when only percent MRSA is monitored.
对耐甲氧西林金黄色葡萄球菌（MRSA）医疗保健相关感染率的担忧促使人们呼吁进行强制性筛查或报告，以努力减少MRSA感染。
研究美国重症监护病房（ICU）中MRSA中心静脉导管相关血流感染（BSI）的发病率趋势。
设计、设置和参与者：利用医院向疾病控制和预防中心（CDC）报告的1997 - 2007年数据，计算7种类型的成人及非新生儿儿科ICU的汇总年均中心静脉导管相关BSI发病率。MRSA百分比定义为金黄色葡萄球菌中心静脉导管相关BSI中MRSA的比例。我们使用回归模型来估计分析期内中心静脉导管相关BSI指标的百分比变化。
每1000个中心静脉导管日的中心静脉导管相关BSI发病率；金黄色葡萄球菌中心静脉导管相关BSI中MRSA的百分比。
总体而言，来自1684个ICU报告了33587例中心静脉导管相关BSI，代表16225498个患者监测日；2498例报告的中心静脉导管相关BSI（7.4%）为MRSA，1590例（4.7%）为甲氧西林敏感金黄色葡萄球菌（MSSA）。在所评估的ICU类型中，外科、非教学附属内科 - 外科、心胸和冠心病监护病房在1997 - 2001年期间MRSA中心静脉导管相关BSI发病率有所增加；然而，内科、教学附属内科 - 外科和儿科病房没有显著变化。从2001年到2007年，除儿科病房发病率保持稳定外，所有ICU类型中MRSA中心静脉导管相关BSI发病率均显著下降。MRSA中心静脉导管相关BSI发病率的下降幅度从非教学附属内科 - 外科ICU的-51.5%（95%CI，-33.7%至-64.6%；P <.001）（每1000个中心静脉导管日从0.31降至0.15）到外科ICU的-69.2%（95%CI，-57.9%至-77.7%；P <.001）（每1000个中心静脉导管日从0.58降至0.18）。在所有ICU类型中，MSSA中心静脉导管相关BSI发病率从1997年到2007年下降，发病率变化范围从外科ICU的-60.1%（95%CI，-41.2%至-73.1%；P <.001）（每1000个中心静脉导管日从0.24降至0.10）到内科ICU的-77.7%（95%CI，-68.2%至-84.4%；P <.001）（每1000个中心静脉导管日从0.40降至0.09）。尽管在1997 - 2007年期间，金黄色葡萄球菌中心静脉导管相关BSI中由MRSA引起的总体比例增加了25.8%（P =.02），但在此期间总体MRSA中心静脉导管相关BSI发病率下降了49.6%（P <.001）。
近年来，向CDC报告的大多数ICU类型中，MRSA中心静脉导管相关BSI的发病率一直在下降。仅监测MRSA百分比时，这些趋势并不明显。
