高流行地区重症监护病房中主动监测和接触隔离对耐甲氧西林金黄色葡萄球菌传播的影响。
Impact of active surveillance and contact isolation on transmission of methicillin-resistant Staphylococcus aureus in intensive care units in an area with high prevalence.
机构信息
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
出版信息
J Formos Med Assoc. 2010 Apr;109(4):258-68. doi: 10.1016/S0929-6646(10)60051-4.
BACKGROUND/PURPOSE: Previous research has suggested that active surveillance and early initiation of contact isolation (ASI) can control the nosocomial spread of methicillin-resistant Staphylococcus aureus (MRSA), especially among intensive care unit (ICU) patients. However, these interventions have never been implemented in Taiwan.
METHODS
This study was conducted from September 2005 to October 2006 to evaluate the effect of ASI on the spread of MRSA in two medical centers in Taiwan with a high prevalence of MRSA. One ICU from each hospital was selected as a study site. In phase I (the first 6 months), only active surveillance was introduced. In phase II (the final 6 months), ASI for patients who had positive MRSA cultures was implemented.
RESULTS
The incidence of acquiring MRSA during ICU stay did not differ significantly during phases I and II in hospital A (p = 0.940) and hospital B (p = 0.810). The independent risk factors for acquiring MRSA in the ICU were length of stay and presence of respiratory tract diseases.
CONCLUSION
This study demonstrated that, given the current resource limitations, ASI alone could not reduce MRSA transmission in two ICUs in Taiwan, where the MRSA prevalence was high.
背景/目的：先前的研究表明，主动监测和早期实施接触隔离（ASI）可以控制耐甲氧西林金黄色葡萄球菌（MRSA）的医院内传播，尤其是在重症监护病房（ICU）患者中。然而，这些干预措施在台湾从未实施过。
方法
本研究于 2005 年 9 月至 2006 年 10 月在台湾两家 MRSA 高发的医学中心进行，旨在评估 ASI 对 MRSA 传播的影响。每家医院各选择一个 ICU 作为研究地点。在第一阶段（前 6 个月），仅引入主动监测。在第二阶段（最后 6 个月），对 MRSA 培养阳性的患者实施 ASI。
结果
在医院 A（p = 0.940）和医院 B（p = 0.810），ICU 住院期间获得 MRSA 的发生率在第一阶段和第二阶段没有显著差异。在 ICU 中获得 MRSA 的独立危险因素是住院时间和呼吸道疾病的存在。
结论
本研究表明，鉴于目前的资源限制，主动监测单独不能降低台湾两家 MRSA 流行率较高的 ICU 中 MRSA 的传播。
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