入院时急性护理退伍军人事务医院耐甲氧西林金黄色葡萄球菌的鼻腔外定植。

Extranasal methicillin-resistant Staphylococcus aureus colonization at admission to an acute care Veterans Affairs hospital.

机构信息

Veterans Affairs Boston Health Care System, Boston, Massachusetts 02130, USA.

出版信息

Infect Control Hosp Epidemiol. 2010 Jan;31(1):42-6. doi: 10.1086/649222.

DOI:10.1086/649222

PMID:19954335

Abstract

OBJECTIVE

To evaluate the prevalence of and risk factors for extranasal methicillin-resistant Staphylococcus aureus (MRSA) colonization and its relationship to nasal colonization among veterans hospitalized for acute care.

DESIGN

Prospective observational study.

SETTING

Veterans Affairs (VA) acute care hospital in Boston, Massachusetts.

PATIENTS

Convenience sample of 150 patients hospitalized within the previous 36 hours and screened for nasal MRSA who were not known to have an active MRSA infection or MRSA isolates recovered from a wound during the past 12 months.

METHODS

Potential risk factors for MRSA colonization were assessed, and oropharynx, axilla, hand, perirectal, wound, and catheter insertion site samples were obtained for culture. MRSA was identified in chromogenic agar and confirmed by use of routine culture techniques. Nasal MRSA colonization was detected by means of polymerase chain reaction (PCR).

RESULTS

Nasal swab samples analyzed by use of PCR yielded results positive for MRSA in 16 (11%) of 150 patients. Extranasal cultures yielded positive results for 3 (2%) of 134 patients who tested negative for nasal MRSA colonization and for 9 (56%) of 16 patients who tested positive for nasal MRSA colonization (odds ratio [OR], 56.1 [95% confidence interval {CI}, 12.4-254.6]; p < .001). The oropharynx was the most commonly colonized extranasal site (10 patients [7%]). Independent risk factors for extranasal MRSA colonization included nasal MRSA colonization (OR, 66.9 [95% CI, 11.8-379.7]; P < .001) and end-stage hepatic disease (OR, 98.5 [95% CI, 3.1-3,112.4]; P = .01).

CONCLUSIONS

Extranasal MRSA colonization is infrequent among veterans admitted for acute care to VA Boston Healthcare System. Extranasal MRSA colonization was strongly associated with nasal MRSA colonization, which suggests that the VA MRSA Prevention Initiative is not missing a large number of MRSA-colonized patients by focusing on nasal-only screening.

摘要

目的

评估退伍军人急性住院患者中非鼻腔耐甲氧西林金黄色葡萄球菌（MRSA）定植的流行率和危险因素及其与鼻腔定植的关系。

设计

前瞻性观察性研究。

地点

马萨诸塞州波士顿退伍军人事务部（VA）急性护理医院。

患者

在过去 36 小时内住院且正在筛查鼻腔 MRSA 的 150 名患者的方便样本，这些患者均无已知的活动性 MRSA 感染或过去 12 个月从伤口中分离出的 MRSA 株。

方法

评估 MRSA 定植的潜在危险因素，并采集口咽、腋窝、手、直肠周围、伤口和导管插入部位样本进行培养。在显色琼脂上鉴定 MRSA，并通过常规培养技术进行确认。通过聚合酶链反应（PCR）检测鼻腔 MRSA 定植。

结果

通过 PCR 分析鼻腔拭子样本，150 名患者中有 16 名（11%）的结果为 MRSA 阳性。134 名鼻腔 MRSA 定植阴性患者中，134 名患者中有 3 名（2%）的非鼻腔培养结果为阳性，16 名鼻腔 MRSA 定植阳性患者中有 9 名（56%）的非鼻腔培养结果为阳性（比值比[OR]，56.1 [95%置信区间{CI}，12.4-254.6]；p<0.001）。最常见的非鼻腔定植部位是口咽（10 名患者[7%]）。非鼻腔 MRSA 定植的独立危险因素包括鼻腔 MRSA 定植（OR，66.9 [95% CI，11.8-379.7]；P<0.001）和终末期肝病（OR，98.5 [95% CI，3.1-3112.4]；P=0.01）。