Jarlier Vincent, Trystram David, Brun-Buisson Christian, Fournier Sandra, Carbonne Anne, Marty Laurence, Andremont Antoine, Arlet Guillaume, Buu-Hoi Annie, Carlet Jean, Decré Dominique, Gottot Serge, Gutmann Laurent, Joly-Guillou Marie-Laure, Legrand Patrick, Nicolas-Chanoine Marie-Hélène, Soussy Claude-James, Wolf Michel, Lucet Jean-Christophe, Aggoune Michelle, Brücker Gilles, Régnier Bernard
Université Pierre et Marie Curie-Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, France.
Arch Intern Med. 2010 Mar 22;170(6):552-9. doi: 10.1001/archinternmed.2010.32.
The Assistance Publique-Hôpitaux de Paris (AP-HP) institution administers 38 teaching hospitals (23 acute care and 15 rehabilitation and long-term care hospitals; total, 23 000 beds) scattered across Paris and surrounding suburbs in France. In the late 1980s, the proportion of methicillin resistance among clinical strains of Staphylococcus aureus (MRSA) reached approximately 40% at AP-HP.
A program aimed at curbing the MRSA burden was launched in 1993, based on passive and active surveillance, barrier precautions, training, and feedback. This program, supported by the strong commitment of the institution, was reinforced in 2001 by a campaign promoting the use of alcohol-based hand-rub solutions. An observational study on MRSA rate was prospectively carried out from 1993 onwards.
There was a significant progressive decrease in MRSA burden (-35%) from 1993 to 2007, whether recorded as the proportion (expressed as percentage) of MRSA among S aureus strains (41.0% down to 26.6% overall; 45.3% to 24.2% in blood cultures) or incidence of MRSA cases (0.86 down to 0.56 per 1000 hospital days). The MRSA burden decreased more markedly in intensive care units (-59%) than in surgical (-44%) and medical (-32%) wards. The use of ABHR solutions (in liters per 1000 hospital days) increased steadily from 2 L to 21 L (to 26 L in acute care hospitals and to 10 L in rehabilitation and long-term care hospitals) following the campaign.
A sustained reduction of MRSA burden can be obtained at the scale of a large hospital institution with high endemic MRSA rates, providing that an intensive program is maintained for a long period.
巴黎公共救助医院集团（AP-HP）管理着分布在法国巴黎及周边郊区的38家教学医院（23家急症护理医院以及15家康复与长期护理医院；共计23000张床位）。20世纪80年代末，巴黎公共救助医院集团临床分离的金黄色葡萄球菌（MRSA）耐甲氧西林比例达到约40%。
1993年启动了一项旨在控制MRSA负担的项目，该项目基于被动和主动监测、屏障预防措施、培训及反馈。在该机构的大力支持下，此项目于2001年通过一项推广使用含酒精洗手液的活动得到强化。从1993年起前瞻性地开展了一项关于MRSA发生率的观察性研究。
1993年至2007年，MRSA负担显著逐步下降（-35%），无论是以MRSA在金黄色葡萄球菌菌株中的比例（以百分比表示）记录（总体从41.0%降至26.6%；血培养中从45.3%降至24.2%），还是以MRSA病例的发生率记录（从每1000个住院日0.86降至0.56）。重症监护病房的MRSA负担下降更为明显（-59%），高于外科病房（-44%）和内科病房（-32%）。活动开展后，含酒精洗手液的使用量（每1000个住院日的升数）从2升稳步增加至21升（急症护理医院增至26升，康复与长期护理医院增至10升）。
在MRSA高流行率的大型医院机构范围内，只要长期维持强化项目，就能持续降低MRSA负担。
