Vos Margreet C, Behrendt Myra D, Melles Damian C, Mollema Femke P N, de Groot Woutrinus, Parlevliet Gerard, Ott Alewijn, Horst-Kreft Deborah, van Belkum Alex, Verbrugh Henri A
Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center Rotterdam, the Netherlands.
Infect Control Hosp Epidemiol. 2009 Oct;30(10):977-84. doi: 10.1086/605921.
To evaluate the effectiveness of a rigorous search and destroy policy for controlling methicillin-resistant Staphylococcus aureus (MRSA) infection or colonization.
Hospital-based observational follow-up study.
Erasmus University Medical Center Rotterdam, a 1,200-bed tertiary care center in Rotterdam, the Netherlands.
Outbreak control was accomplished by the use of active surveillance cultures for persons at risk, by the preemptive isolation of patients at risk, and by the strict isolation of known MRSA carriers and the eradication of MRSA carriage. For unexpected cases of MRSA colonization or infection, patients placed in strict isolation or contact isolation and healthcare workers (HCWs) were screened. We collected data from 2000-2004.
During the 5-year study period, 51,907 MRSA screening cultures were performed for 21,598 persons at risk (8,403 patients and 13,195 HCWs). By screening, it was determined that 123 (1.5%) of 8,403 patients and 31 (0.2%) of 13,195 HCWs were MRSA carriers. From the performance of clinical cultures, it was determined that 54 additional patients were MRSA carriers, resulting in a total of 177 patients carrying MRSA. Of the 177 patients carrying MRSA, 144 (81%) were primary patients, and 33 (19%) secondary patients. The average number of nosocomial transmissions was 6.7 per year. The cumulative incidence of MRSA colonization among this group of patients was 0.10 cases per 100 admissions. Of 156 cases of MRSA colonization, 44 (28%) were acquired in a foreign healthcare institution, and 45 (29%) were acquired in other Dutch hospitals, 22 (47%) of which were acquired in a single hospital in our region. There were 16 cases (10%) that occurred in a nursing home and another 16 cases (10%) that fulfilled our definition of community-acquired MRSA colonization; there were 4 cases (3%) categorized as "other" and 31 cases (20%) for which the source of MRSA acquisition remained unknown. The basic reproduction rate was 10-fold less for patients isolated on admission, compared with those who were not. During the 5-year study period, 5 episodes of MRSA bacteremia occurred in which 4 patients died, an incidence rate of 0.28 cases of infection per 100,000 patient-days per year.
Our results show that, during a rigorous search and destroy policy, a low incidence of MRSA in our medical center was continuously observed and that this policy most likely contributed to a very low nosocomial transmission rate.
评估严格的筛查与清除策略对控制耐甲氧西林金黄色葡萄球菌（MRSA）感染或定植的有效性。
基于医院的观察性随访研究。
荷兰鹿特丹的伊拉斯姆斯大学医学中心，一家拥有1200张床位的三级护理中心。
通过对高危人群进行主动监测培养、对高危患者进行预防性隔离、对已知的MRSA携带者进行严格隔离以及清除MRSA定植来实现暴发控制。对于意外的MRSA定植或感染病例，对处于严格隔离或接触隔离的患者以及医护人员（HCWs）进行筛查。我们收集了2000年至2004年的数据。
在5年的研究期间，对21598名高危人群（8403名患者和13195名医护人员）进行了51907次MRSA筛查培养。通过筛查确定，8403名患者中有123名（1.5%）以及13195名医护人员中有31名（0.2%）为MRSA携带者。根据临床培养结果，又确定了54名患者为MRSA携带者，使得携带MRSA的患者总数达到177名。在这177名携带MRSA的患者中，144名（81%）为原发患者，33名（19%）为继发患者。医院内传播的平均年数为6.7次。该组患者中MRSA定植的累积发病率为每100次入院0.10例。在156例MRSA定植病例中，44例（28%）在国外医疗机构获得，45例（29%）在荷兰其他医院获得，其中22例（47%）在我们所在地区的一家医院获得。有16例（10%）发生在养老院，另有16例（10%）符合我们对社区获得性MRSA定植的定义；有4例（3%）归类为“其他”，31例（20%）的MRSA获得来源不明。与未入院时隔离的患者相比，请入院时隔离的患者的基本繁殖率低10倍。在5年的研究期间，发生了5例MRSA菌血症，其中4例患者死亡，每年每100000患者日的感染发病率为0.28例。
我们的结果表明，在严格的筛查与清除策略实施期间，我们医疗中心的MRSA发病率持续较低，并且该策略很可能促成了非常低的医院内传播率。
