Wibbenmeyer Lucy, Williams Ingrid, Ward Melissa, Xiao Xiangjun, Light Timothy, Latenser Barbara, Lewis Robert, Kealey Gerald Patrick, Herwaldt Loreen
Department of Surgery, The University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.
J Burn Care Res. 2010 Mar-Apr;31(2):269-79. doi: 10.1097/BCR.0b013e3181d0f479.
The incidence of hospital-associated infections secondary to methicillin-resistant Staphylococcus aureus (MRSA) and those caused by vancomycin-resistant enterococci (VRE) continue to increase, despite the publication of evidence-based guidelines on infection control. We sought to determine modifiable risks factors for acquisition of MRSA or VRE or both on a burn trauma unit (BTU). We performed a retrospective single-center-matched control study. Our study group comprised 94 patients who acquired MRSA or VRE or both while on the BTU from January 1, 2001 to December 31, 2005. The case-patients were matched 1:1 to control-patients based on the time the cases were exposed to the BTU before they became colonized or infected. Logistic regression was used to analyze the relationship of demographic, procedure, and antimicrobial exposure variables to acquisition of MRSA or VRE. Acquisition of MRSA or VRE was related to patient factors, antimicrobial exposure, and device use. Younger age and prior vancomycin treatment while on the BTU were independently associated with MRSA acquisition. The presence of a Foley catheter was related to VRE acquisition. Sixteen study patients (17.0%) who became colonized on the BTU subsequently acquired 17 infections: six patients had MRSA bloodstream infections, nine had MRSA burn wound infections, and two had VRE urinary tract infections. Younger age, exposure to vancomycin, or Foley catheters were associated with increased risk of acquiring MRSA or VRE. Protocols or algorithms that help physicians remember to assess the necessity of antimicrobial agents and devices may help limit the duration of exposure to these risk factors, which may enhance infection prevention efforts. Future studies need to explore the effect of these variables on cross-transmission and their impact predominately in a burn unit.
尽管已发布基于证据的感染控制指南，但耐甲氧西林金黄色葡萄球菌（MRSA）引起的医院相关感染以及耐万古霉素肠球菌（VRE）引起的感染发生率仍在持续上升。我们试图确定烧伤创伤病房（BTU）中获得MRSA或VRE或两者的可改变风险因素。我们进行了一项回顾性单中心匹配对照研究。我们的研究组包括94例在2001年1月1日至2005年12月31日期间在BTU获得MRSA或VRE或两者的患者。根据病例在定植或感染前接触BTU的时间，将病例患者与对照患者按1:1进行匹配。采用逻辑回归分析人口统计学、手术和抗菌药物暴露变量与获得MRSA或VRE之间的关系。获得MRSA或VRE与患者因素、抗菌药物暴露和设备使用有关。年龄较小以及在BTU期间先前接受万古霉素治疗与获得MRSA独立相关。留置导尿管与获得VRE有关。16名在BTU定植的研究患者（17.0%）随后发生了17次感染：6例患者发生MRSA血流感染，9例患者发生MRSA烧伤创面感染，2例患者发生VRE尿路感染。年龄较小以及接触万古霉素或留置导尿管与获得MRSA或VRE的风险增加有关。有助于医生记住评估抗菌药物和设备必要性的方案或算法可能有助于限制暴露于这些风险因素的持续时间，这可能会加强感染预防工作。未来的研究需要探讨这些变量对交叉传播的影响以及它们在烧伤病房中的主要影响。
