Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy.
Infect Control Hosp Epidemiol. 2011 Nov;32(11):1109-15. doi: 10.1086/662184. Epub 2011 Sep 20.
Information on the risk of methicillin-resistant Staphylococcus aureus (MRSA) infection transmission in dental healthcare settings was incomplete only few years ago; therefore, MRSA infection control guidelines were necessarily based on data extrapolated from other fields. Recently, publication of specific studies have made it possible to review such risk.
Studies of MRSA infection in dentistry were searched for using EMBASE, MEDLINE, and Google and were allocated into the following sections: (1) direct evidence: documented cases of MRSA transmission in dentistry; (2) indirect evidence: carriage rates among dental healthcare providers (DHCPs) and patients (high carriage rates suggest that transmission is likely); (3) speculative evidence: MRSA occurrence in the dental environment (high environmental contamination probably increases the risk of infection); and (4) speculative evidence: MRSA carriage in human dental plaque and saliva (oral carriers may spread MRSA in the environment during dental therapy, with consequent environmental contamination and probable increased risk of infection).
Our findings were as follows. First, transmission has been ascertained during surgical interventions, particularly in surgical units and among head and neck cancer patients. Second, carriage rates among DHCPs were lower than those among other healthcare workers. Carriage rates among adult patients were low, whereas among pedodontic and special care patients rates were higher than those in the general population. Third, MRSA has been detected in the environment of emergency and surgical units and in dental hospitals. Some individuals in poor general condition were oral MRSA carriers.
The occupational risk of MRSA infection among DHCPs is minimal. Among special patients (eg, special care, hospitalized, and cancer patients) the risk of infection is high, whereas among the remaining patients undergoing conventional therapy such risk is probably low.
仅在几年前，有关牙科医疗环境中耐甲氧西林金黄色葡萄球菌（MRSA）感染传播风险的信息还不完整；因此，MRSA 感染控制指南必须基于从其他领域推断的数据。最近，具体研究的发表使得审查这种风险成为可能。
使用 EMBASE、MEDLINE 和 Google 搜索了有关牙科 MRSA 感染的研究，并将其分为以下几类：（1）直接证据：牙科中 MRSA 传播的已记录病例；（2）间接证据：牙科保健提供者（DHCP）和患者中的携带率（高携带率表明传播很可能发生）；（3）推测性证据：牙科环境中的 MRSA 发生情况（高环境污染可能会增加感染风险）；以及（4）推测性证据：人类牙菌斑和唾液中的 MRSA 携带情况（口腔携带者在牙科治疗期间可能会将 MRSA 传播到环境中，从而导致环境污染和感染风险增加）。
我们的发现如下。首先，在外科手术中已经确定了传播，特别是在外科病房和头颈部癌症患者中。其次，DHCP 的携带率低于其他医护人员。成年患者的携带率较低，而儿科和特殊护理患者的携带率高于普通人群。第三，MRSA 已在急诊和外科病房以及牙科医院的环境中被检测到。一些身体状况不佳的个体是口腔 MRSA 携带者。
DHCP 中 MRSA 感染的职业风险很小。在特殊患者（例如特殊护理、住院和癌症患者）中，感染风险很高，而在接受常规治疗的其余患者中，这种风险可能较低。
