在重症监护病房中，为了筛查耐甲氧西林金黄色葡萄球菌的定植而常规采集的鼻拭子，是一种针对该病原体在临床培养物中的敏感筛查试验。
Nasal swabs collected routinely to screen for colonization by methicillin-resistant Staphylococcus aureus in intensive care units are a sensitive screening test for the organism in clinical cultures.
机构信息
Department of Trauma , North Memorial Medical Center, Robbinsdale, MN, USA.
出版信息
Surg Infect (Larchmt). 2010 Dec;11(6):511-5. doi: 10.1089/sur.2010.033.
BACKGROUND
Many hospitals screen patients for methicillin-resistant Staphylococcus aureus (MRSA) on admission to the intensive care unit (ICU). We hypothesized that this screening information could be used to assist with empiric antibiotic decisions.
METHODS
The medical records of patients admitted to a university-affiliated community hospital as well as a tertiary-care university hospital were reviewed. Patients admitted to the ICU were screened for MRSA colonization with a nasal swab that was analyzed with either chromogenic medium (hospital 1) or polymerase chain reaction (PCR) (hospital 2). The results of the nasal swab were compared with clinical culture results.
RESULTS
There were 141 patients, and 167 cultures were obtained. The majority of the cultures (70%) were performed on sputum specimens in an effort to diagnose pneumonia. The remaining cultures were performed on blood (10.1%), incisions (21.5%), and urine (3.4%). The overall sensitivity of nasal swab results was 69.5%. However, the sensitivity was significantly higher for nasal swab screening performed within six days of clinical cultures compared with screening performed seven days or more before cultures were obtained. (79% vs. 46%; p < 0.0001). Sensitivity also differed significantly depending on the surveillance method, being significantly higher among patients screened with PCR within six days of developing an infection than in patients screened with chromogenic medium (88% vs. 65.5%; p = 0.006).
CONCLUSION
Screening with PCR analysis of nasal swab specimens is a highly sensitive test for MRSA in clinical cultures. Clinicians may be able to use the swab results to tailor more appropriate empiric antimicrobial regimens. The results with chromogenic medium screening are markedly poorer, which suggests that clinicians should view them with caution.
背景
许多医院在患者入住重症监护病房（ICU）时对耐甲氧西林金黄色葡萄球菌（MRSA）进行筛查。我们假设这些筛查信息可用于辅助经验性抗生素决策。
方法
回顾了一家大学附属医院和一家三级大学医院收治的患者的病历。对入住 ICU 的患者进行鼻拭子 MRSA 定植筛查，采用显色培养基（医院 1）或聚合酶链反应（PCR）（医院 2）进行分析。将鼻拭子结果与临床培养结果进行比较。
结果
共纳入 141 例患者，获得 167 份培养物。大部分培养物（70%）取自痰标本，以诊断肺炎。其余培养物取自血液（10.1%）、切口（21.5%）和尿液（3.4%）。鼻拭子结果的整体敏感性为 69.5%。然而，与培养前 7 天或以上进行的筛查相比，在临床培养前 6 天内进行的鼻拭子筛查的敏感性明显更高（79%比 46%；p<0.0001）。敏感性也因监测方法而异，在感染发生后 6 天内接受 PCR 筛查的患者明显高于接受显色培养基筛查的患者（88%比 65.5%；p=0.006）。
结论
采用 PCR 分析鼻拭子标本对临床培养物中的 MRSA 进行筛查是一种高度敏感的检测方法。临床医生可能能够利用拭子结果来制定更合适的经验性抗菌治疗方案。采用显色培养基筛查的结果明显较差，这表明临床医生应谨慎对待。
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