Sección de Enfermedades Infecciosas, Servicio de Microbiología, Hospital Universitario Virgen Macarena, and the Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain.
Infect Control Hosp Epidemiol. 2010 Aug;31(8):786-95. doi: 10.1086/654003.
To evaluate the long-term impact of successive interventions on rates of methicillin-resistant Staphylococcus aureus (MRSA) colonization or infection and MRSA bacteremia in an endemic hospital-wide situation.
Quasi-experimental, interrupted time-series analysis. The impact of the interventions was analyzed by use of segmented regression. Representative MRSA isolates were typed by use of pulsed-field gel electrophoresis.
A 950-bed teaching hospital in Seville, Spain.
All patients admitted to the hospital during the period from 1995 through 2008.
Three successive interventions were studied: (1) contact precautions, with no active surveillance for MRSA; (2) targeted active surveillance for MRSA in patients and healthcare workers in specific wards, prioritized according to clinical epidemiology data; and (3) targeted active surveillance for MRSA in patients admitted from other medical centers.
Neither the preintervention rate of MRSA colonization or infection (0.56 cases per 1,000 patient-days [95% confidence interval {CI}, 0.49-0.62 cases per 1,000 patient-days]) nor the slope for the rate of MRSA colonization or infection changed significantly after the first intervention. The rate decreased significantly to 0.28 cases per 1,000 patient-days (95% CI, 0.17-0.40 cases per 1,000 patient-days) after the second intervention and to 0.07 cases per 1,000 patient-days (95% CI, 0.06-0.08 cases per 1,000 patient-days) after the third intervention, and the rate remained at a similar level for 8 years. The MRSA bacteremia rate decreased by 80%, whereas the rate of bacteremia due to methicillin-susceptible S. aureus did not change. Eighty-three percent of the MRSA isolates identified were clonally related. All MRSA isolates obtained from healthcare workers were clonally related to those recovered from patients who were in their care.
Our data indicate that long-term control of endemic MRSA is feasible in tertiary care centers. The use of targeted active surveillance for MRSA in patients and healthcare workers in specific wards (identified by means of analysis of clinical epidemiology data) and the use of decolonization were key to the success of the program.
评估连续干预措施对耐甲氧西林金黄色葡萄球菌（MRSA）定植或感染率以及医院内 MRSA 菌血症的长期影响。
准实验、间断时间序列分析。采用分段回归分析干预措施的影响。采用脉冲场凝胶电泳对代表性的 MRSA 分离株进行分型。
西班牙塞维利亚的一家 950 床位教学医院。
1995 年至 2008 年期间入住该医院的所有患者。
研究了 3 项连续干预措施：（1）接触预防措施，不进行 MRSA 主动监测；（2）根据临床流行病学数据对特定病房的患者和医护人员进行 MRSA 目标性主动监测，按优先顺序进行；（3）对来自其他医疗中心的入院患者进行 MRSA 目标性主动监测。
在第一项干预措施实施前，MRSA 定植或感染的发生率（0.56 例/1000 患者日[95%置信区间{CI}，0.49-0.62 例/1000 患者日]）和发生率的斜率均无显著变化。在第二项干预措施实施后，发生率显著下降至 0.28 例/1000 患者日（95%CI，0.17-0.40 例/1000 患者日），在第三项干预措施实施后进一步下降至 0.07 例/1000 患者日（95%CI，0.06-0.08 例/1000 患者日），此后 8 年该发生率一直保持在类似水平。MRSA 菌血症的发生率下降了 80%，而耐甲氧西林金黄色葡萄球菌引起的菌血症发生率没有变化。83%的 MRSA 分离株为克隆相关。从医护人员中分离到的所有 MRSA 分离株与他们护理的患者的分离株在克隆上均有关联。
我们的数据表明，在三级保健中心实施长期的耐甲氧西林金黄色葡萄球菌控制是可行的。对特定病房的患者和医护人员（通过临床流行病学数据分析确定）进行 MRSA 目标性主动监测以及进行去定植是该方案成功的关键。
