Department of Infectious Diseases, Singapore General Hospital, Singapore.
Am J Infect Control. 2010 Jun;38(5):361-7. doi: 10.1016/j.ajic.2009.09.018. Epub 2010 Feb 26.
Active surveillance testing (AST) and decontamination strategies (DS) using a topical methicillin-resistant Staphylococcus aureus (MRSA) cleansing agent was introduced in July 2007 in a medical intensive care unit (MICU) and a surgical ICU (SICU) of a tertiary care hospital to reduce the incidence of MRSA infection.
Data on ICU admissions between July 1, 2007, and June 30, 2008, was analyzed. All subjects, excluding known MRSA status, had an ICU length of stay (LOS) of more than 24 hours and nasal swabs performed on ICU admission, every 7 days during the ICU stay, and on discharge. MICU and SICU specimens were sent for culture and in-house real-time polymerase chain reaction, respectively. MRSA-colonized (MRSAc) patients were subjected to contact isolation precautions and DS for 5 days or until ICU discharge. Data recorded included demographics, LOS, and antibiotic use. Results were analyzed using SPSS. Control charts were used to determine special cause variation.
Of 653 eligible patients admitted to the ICU, 85 (13%) were determined to be MRSAc on ICU admission. A further 15% (52 of 351) were determined to be MRSAc during the ICU stay or at discharge. Thus, AST detected MRSA in at least 137 of the 653 patients (21.0%). In contrast, clinical cultures for MRSA were positive in only 12 patients (1.8%). Compared with noncolonized patients, MRSAc patients at any screening point had a longer pre-ICU LOS (P =.001), received more antibiotics (P = .004), and had a longer ICU LOS (P = .003). Compared with the preintervention period of July 2006 to June 2007, there was no significant reduction in mean MRSA infection incidence rate in both ICUs (3.8 to 3.0 per 1000 patient-days [P = .057] in the SICU and 1.4 to 1.7 per 1000 patient-days in the MICU) following intervention.
In ICUs, AST detected 11 times more MRSA than clinical cultures. The lack of reduction in MRSA infection rates in the ICUs does not negate the roles of AST and DS, but does argue for better study design and outcome measures like MRSA transmission incidence, which perhaps would have demonstrated a true benefit of AST and DS.
2007 年 7 月，在一家三级医院的重症监护病房（MICU）和外科重症监护病房（SICU）中引入了使用局部耐甲氧西林金黄色葡萄球菌（MRSA）清洁剂的主动监测检测（AST）和去污策略（DS），以降低 MRSA 感染的发生率。
分析了 2007 年 7 月 1 日至 2008 年 6 月 30 日期间 ICU 入住患者的数据。除已知的 MRSA 状态外，所有患者的 ICU 入住时间（LOS）均超过 24 小时，并在 ICU 入住时、入住期间的每 7 天以及出院时进行鼻拭子检查。MICU 和 SICU 标本分别进行培养和内部实时聚合酶链反应。MRSA 定植（MRSAc）患者接受接触隔离预防措施和 DS，持续 5 天或直至 ICU 出院。记录的数据包括人口统计学、LOS 和抗生素使用情况。使用 SPSS 分析结果。控制图用于确定特殊原因的变化。
在 653 名符合条件的 ICU 入住患者中，有 85 名（13%）在 ICU 入住时被确定为 MRSAc。另有 15%（52/351）在 ICU 入住期间或出院时被确定为 MRSAc。因此，AST 在至少 653 名患者中的 137 名（21.0%）中检测到了 MRSA。相比之下，临床培养 MRSA 的阳性率仅为 12 名患者（1.8%）。与非定植患者相比，任何筛查点的 MRSAc 患者的 ICU 前 LOS 更长（P=0.001），接受的抗生素更多（P=0.004），且 ICU LOS 更长（P=0.003）。与 2006 年 7 月至 2007 年 6 月的干预前相比，两个 ICU 的平均 MRSA 感染发生率均无显著降低（SICU 为每 1000 患者日 3.8 至 3.0，MICU 为每 1000 患者日 1.4 至 1.7）。
在 ICU 中，AST 检测到的 MRSA 比临床培养多 11 倍。两个 ICU 中 MRSA 感染率没有降低，这并不能否定 AST 和 DS 的作用，但确实需要更好的研究设计和结果衡量指标，如 MRSA 传播发生率，这可能会证明 AST 和 DS 的真正益处。
