主动监测和去定植方案实施后，医疗重症监护病房金黄色葡萄球菌定植和医院获得性感染减少。

Decrease in Staphylococcus aureus colonization and hospital-acquired infection in a medical intensive care unit after institution of an active surveillance and decolonization program.

机构信息

Medicine Institute, Department of Infectious Disease, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.

出版信息

Infect Control Hosp Epidemiol. 2010 Aug;31(8):779-83. doi: 10.1086/654001.

DOI:10.1086/654001

PMID:20594110

Abstract

OBJECTIVE

To evaluate the effects of an active surveillance program for Staphylococcus aureus linked to a decolonization protocol on the incidence of healthcare-associated infection and new nasal colonization due to S. aureus.

DESIGN

Retrospective quasi-experimental study.

SETTING

An 18-bed medical intensive care unit at a tertiary care center in Cleveland, Ohio.

METHODS

From January 1, 2006, through December 31, 2007, all patients in the medical intensive care unit were screened for S. aureus nasal carriage at admission and weekly thereafter. During the preintervention period, January 1 through September 30, 2006, only surveillance occurred. During the intervention period, January 1 through December 31, 2007, S. aureus carriers received mupirocin intranasally. Beginning in February 2007, carriers also received chlorhexidine gluconate baths.

RESULTS

During the preintervention period, 604 (73.7%) of 819 patients were screened for S. aureus nasal carriage, yielding 248 prevalent carriers (30.3%). During the intervention period, 752 (78.3%) of 960 patients were screened, yielding 276 carriers (28.8%). The incidence of S. aureus carriage decreased from 25 cases in 3,982 patient-days (6.28 cases per 1,000 patient-days) before intervention to 18 cases in 5,415 patient-days (3.32 cases per 1,000 patient-days) (P=.04; relative risk [RR], 0.53 [95% confidence interval {CI}, 0.28-0.97]) and from 9.57 to 4.77 cases per 1,000 at-risk patient-days (P=.02; RR, 0.50 [95% CI, 0.27-0.91]). The incidence of S. aureus hospital-acquired bloodstream infection during the 2 periods was 2.01 and 1.11 cases per 1,000 patient-days, respectively (P=.28). The incidence of S. aureus ventilator-associated pneumonia decreased from 1.51 to 0.18 cases per 1,000 patient-days (P=.03; RR, 0.12 [95% CI, 0.01-0.83]). The total incidence of S. aureus hospital-acquired infection decreased from 3.52 to 1.29 cases per 1,000 patient-days (P=.03; RR, 0.37 [95% CI, 0.14-0.90]).

CONCLUSIONS

Active surveillance for S. aureus nasal carriage combined with decolonization was associated with a decreased incidence of S. aureus colonization and hospital-acquired infection.

摘要

目的

评估与去定植方案相关的金黄色葡萄球菌主动监测计划对与医疗保健相关的金黄色葡萄球菌感染和新的鼻腔定植的发生率的影响。

设计

回顾性准实验研究。

地点

俄亥俄州克利夫兰市一家三级护理中心的 18 张病床的医疗重症监护病房。

方法

从 2006 年 1 月 1 日至 2007 年 12 月 31 日，重症监护病房的所有患者在入院时和此后每周进行金黄色葡萄球菌鼻腔携带筛查。在干预前期间，即 2006 年 1 月 1 日至 9 月 30 日，仅进行监测。在干预期间，即 2007 年 1 月 1 日至 12 月 31 日，金黄色葡萄球菌携带者接受莫匹罗星鼻腔内用药。从 2007 年 2 月开始，携带者还接受葡萄糖酸氯己定沐浴。

结果

在干预前期间，对 819 名患者中的 604 名（73.7%）进行了金黄色葡萄球菌鼻腔携带筛查，共发现 248 例现患携带者（30.3%）。在干预期间，对 960 名患者中的 752 名（78.3%）进行了筛查，共发现 276 名携带者（28.8%）。金黄色葡萄球菌携带的发生率从干预前的 3982 个患者日中有 25 例（6.28 例/1000 患者日）降至干预后的 5415 个患者日中有 18 例（3.32 例/1000 患者日）（P=.04；相对风险[RR]，0.53[95%置信区间{CI}，0.28-0.97]），从 9.57 降至 4.77 例/1000 个有风险的患者日（P=.02；RR，0.50[95%CI，0.27-0.91]）。这两个时期金黄色葡萄球菌医院获得性血流感染的发生率分别为 2.01 和 1.11 例/1000 个患者日（P=.28）。金黄色葡萄球菌呼吸机相关性肺炎的发生率从 1.51 降至 0.18 例/1000 个患者日（P=.03；RR，0.12[95%CI，0.01-0.83]）。金黄色葡萄球菌医院获得性感染的总发生率从 3.52 降至 1.29 例/1000 个患者日（P=.03；RR，0.37[95%CI，0.14-0.90]）。