Division of Pediatric Infectious Diseases, Chang Gung Memorial Hospital at Linkou, Kweishan, Taoyuan, Taiwan.
PLoS One. 2011;6(8):e23001. doi: 10.1371/journal.pone.0023001. Epub 2011 Aug 12.
Methicillin-resistant Staphylococcus aureus (MRSA) is among the most important nosocomial pathogens in the intensive care unit (ICU) worldwide, including Taiwan. Since 1997, our neonatal ICUs (NICUs) had become endemic for MRSA.
METHODOLOGY/PRINCIPAL FINDINGS: To control MRSA spread in our NICUs, we implemented a series of infection control measures stepwise, including reinforcement of hand hygiene since January 2000, augmentation of aseptic care over the insertion site of central venous catheter since July 2001, introduction of alcohol-based handrubs since April 2003, surveillance culture for MRSA and cohort care for the colonized patients between March 2003 and February 2004, and surveillance culture with subsequent decolonization of MRSA between August 2005 and July 2006. After implementation of these measures, MRSA healthcare-associated infection (HAI) density reduced by 92%, from 5.47 episodes per 1000 patient-days in 1999 to 0.45 episodes per 1000 patient-days in 2006; MRSA bloodstream infection reduced from 40 cases in 1999 to only one case in 2006. Compared to those obtained during the period of surveillance culture without decolonization, both rates of MRSA colonization (8.6% vs. 41%, p<0.001) and infection (1.1% vs. 12%, p<0.001) decreased significantly during the period of surveillance and decolonization. Molecular analysis of the clinical isolates during the study period showed that the endemic clone, which dominated between 1998 and 2005, almost disappeared in 2006, while the community clones increased significantly in 2006-2007.
CONCLUSION/SIGNIFICANCE: Through infection control measures, MRSA HAIs can be successfully controlled, even in areas with high levels of endemic MRSA infections such as our NICUs.
耐甲氧西林金黄色葡萄球菌（MRSA）是全球重症监护病房（ICU）中最重要的医院获得性病原体之一，包括中国台湾。自 1997 年以来，我们的新生儿 ICU（NICU）已成为耐甲氧西林金黄色葡萄球菌的地方流行株。
方法/主要发现：为了控制耐甲氧西林金黄色葡萄球菌在我们的 NICU 中的传播，我们逐步实施了一系列感染控制措施，包括自 2000 年 1 月以来加强手部卫生，自 2001 年 7 月以来增强中心静脉导管插入部位的无菌护理，自 2003 年 4 月以来引入酒精基洗手液，自 2003 年 3 月至 2004 年 2 月进行耐甲氧西林金黄色葡萄球菌监测培养和定植患者的队列护理，以及自 2005 年 8 月至 2006 年 7 月进行耐甲氧西林金黄色葡萄球菌监测培养和随后的去定植。实施这些措施后，耐甲氧西林金黄色葡萄球菌医院获得性感染（HAI）密度从 1999 年的每千名患者 5.47 例减少到 2006 年的每千名患者 0.45 例，降低了 92%；耐甲氧西林金黄色葡萄球菌血流感染从 1999 年的 40 例减少到 2006 年的 1 例。与未去定植的监测培养期间获得的数据相比，耐甲氧西林金黄色葡萄球菌定植率（8.6%对 41%，p<0.001）和感染率（1.1%对 12%，p<0.001）在监测和去定植期间均显著降低。研究期间临床分离株的分子分析显示，1998 年至 2005 年间占主导地位的地方流行克隆几乎在 2006 年消失，而社区克隆在 2006-2007 年显著增加。
结论/意义：通过感染控制措施，可以成功控制耐甲氧西林金黄色葡萄球菌 HAI，即使在我们的 NICU 等耐甲氧西林金黄色葡萄球菌地方性感染水平较高的地区也是如此。
