Robert Koch Institute, Berlin, Germany.
Clin Microbiol Infect. 2011 Jun;17(6):901-6. doi: 10.1111/j.1469-0691.2010.03409.x. Epub 2010 Dec 3.
Nosocomial infections with methicillin-resistant Staphylococcus aureus (MRSA) account for increased morbidity, mortality and healthcare costs in critically ill patients worldwide. The intensive care unit (ICU) component of the German surveillance system for nosocomial infections (Krankenhaus-Infektions-Surveillance-System, KISS) has been supplemented with a module targeting the surveillance of multiresistant pathogens [Multiresistente Erreger (MRE)-KISS] in order to account for the increasing burden of antibiotic-resistant bacteria. The aim of this study was to assess the association between structural and organizational characteristics of ICUs and the number of nosocomial MRSA cases. Data were derived from routine data collected in the frame of the national surveillance system of nosocomial infections (ICU- and MRE-KISS) from January 2007 to December 2008 and from a questionnaire inquiring about structure and process parameters. One hundred and forty ICUs performing active screening have been included. Process parameters such as isolation of MRSA patients, decolonization procedures and introduction of MRSA alert systems have been implemented by the majority of the ICUs, whereas the application mode of screening procedures and pre-emptive isolation measures is heterogeneous. Multivariable analysis using negative binominal regression models shows that a stay on a medical ICU has a protective effect (incidence rate ratio, 0.42; 95% confidence interval, 0.24-0.74; p = 0.003), whereas the imported MRSA incidence is significantly associated with the number of nosocomial MRSA cases (incidence rate ratio, 1.74; 95% confidence interval, 1.23-2.45; p = 0.002). Structure and process parameters do not show any effect. ICU type and imported MRSA incidence should be considered for benchmarking between hospitals.
耐甲氧西林金黄色葡萄球菌（MRSA）引起的医院感染会增加全球危重病患者的发病率、死亡率和医疗保健费用。德国医院感染监测系统（KISS）的重症监护病房（ICU）部分增加了一个针对多耐药病原体监测的模块[多耐药病原体（MRE）-KISS]，以应对日益增加的抗生素耐药菌负担。本研究旨在评估 ICU 的结构和组织特征与医院获得性 MRSA 病例数量之间的关系。数据来自 2007 年 1 月至 2008 年 12 月国家医院感染监测系统（ICU 和 MRE-KISS）常规收集的数据和询问结构和过程参数的问卷。共纳入了 140 家进行主动筛查的 ICU。大多数 ICU 已经实施了 MRSA 患者的隔离、去定植程序和引入 MRSA 警报系统等程序参数，而筛查程序和先发制人的隔离措施的应用模式则存在差异。使用负二项回归模型的多变量分析表明，入住内科 ICU 具有保护作用（发病率比，0.42；95%置信区间，0.24-0.74；p = 0.003），而输入性 MRSA 发病率与医院获得性 MRSA 病例数量显著相关（发病率比，1.74；95%置信区间，1.23-2.45；p = 0.002）。结构和过程参数没有显示出任何效果。应考虑 ICU 类型和输入性 MRSA 发病率来进行医院间的基准比较。
