Lucet Jean-Christophe, Paoletti Xavier, Demontpion Christine, Degrave Marie, Vanjak Dominique, Vincent Corinne, Andremont Antoine, Jarlier Vincent, Mentré France, Nicolas-Chanoine Marie-Hélène
InfectionControl Unit, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.
Arch Intern Med. 2009 Aug 10;169(15):1372-8. doi: 10.1001/archinternmed.2009.217.
Several studies have documented prolonged colonization with hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) after hospital discharge. However, information is lacking about factors associated with prolonged MRSA colonization and MRSA transmission to household contacts.
From February 2003 to March 2004, adult inpatients (except obstetric patients) were screened for MRSA carriage before discharge to home health care. Bivariate and multivariate analyses were performed to evaluate rates and risk factors of MRSA carriage at discharge, MRSA clearance within 1 year, and MRSA transmission to household contacts.
We identified MRSA in 191 of the 1501 patients screened before discharge to home health care (12.7%). Of the 148 patients with MRSA who were observed, 75 cleared the organism within 1 year, with an estimated median time to clearance of 282 days (95% confidence interval [CI], 233-313 days). Clearance of MRSA was associated with self-sufficiency in daily activities (hazard ratio, 0.63; 95% CI, 0.40-1.00) (P = .049). Of the 188 included household contacts, 36 acquired MRSA (19.1%). Factors associated with household MRSA acquisition were older age (adjusted odds ratio, 1.71 per life decade; 95% CI, 1.32-2.21) (P = .001) and participation in the health care of the index patient (adjusted odds ratio, 3.58; 95% CI, 1.33-9.62) (P = .01).
Hospital-acquired MRSA carriage was common at discharge to home health care and was frequently prolonged. Transmission occurred in nearly 20% of household contacts and was associated with older age and participation in health care of the index patient. Household contacts should apply infection control measures similar to those recommended in the hospital setting.
多项研究记录了出院后医院获得性耐甲氧西林金黄色葡萄球菌（MRSA）长期定植的情况。然而，关于与MRSA长期定植以及MRSA传播给家庭接触者相关的因素，目前尚缺乏相关信息。
2003年2月至2004年3月，对成年住院患者（产科患者除外）在出院接受家庭医疗护理前进行MRSA携带情况筛查。进行双变量和多变量分析，以评估出院时MRSA携带率及危险因素、1年内MRSA清除情况以及MRSA传播给家庭接触者的情况。
在1501例出院接受家庭医疗护理前接受筛查的患者中，我们发现191例（12.7%）携带MRSA。在观察的148例携带MRSA的患者中，75例在1年内清除了该病菌，估计清除的中位时间为282天（95%置信区间[CI]，233 - 313天）。MRSA清除与日常生活自理能力有关（风险比，0.63；95%CI，0.40 - 1.00）（P = 0.049）。在188名纳入研究的家庭接触者中，36例感染了MRSA（19.1%）。与家庭中MRSA感染相关的因素包括年龄较大（校正优势比，每增加10岁为1.71；95%CI，1.32 - 2.21）（P = 0.001）以及参与了索引患者的医疗护理（校正优势比，3.58；95%CI，1.33 - 9.62）（P = 0.01）。
出院接受家庭医疗护理时，医院获得性MRSA携带情况很常见且经常持续较长时间。近20%的家庭接触者发生了传播，这与年龄较大以及参与索引患者的医疗护理有关。家庭接触者应采取与医院环境中推荐的类似感染控制措施。
