Health Protection Scotland, Glasgow, UK.
J Hosp Infect. 2012 Jan;80(1):31-5. doi: 10.1016/j.jhin.2011.09.008. Epub 2011 Nov 21.
A Health Technology Assessment (HTA) model on effectiveness of meticillin-resistant Staphylococcus aureus (MRSA) screening in Scotland suggested that universal screening using chromogenic agar was the preferred option in terms of effectiveness and cost.
To test the model's validity through a one-year pilot-study.
A large one-year prospective cohort study of MRSA screening was carried out in six acute hospitals in NHS Scotland, incorporating 81,438 admissions. Outcomes (MRSA colonization and infection rates) were subjected to multivariable analyses, and trends before and after implementation of screening were compared.
The initial colonization prevalence of 5.5% decreased to 3.5% by month 12 of the study (P < 0.0001). Colonization was associated with the number of admissions per patient, specialty of admission, age, and source of admission (home, other hospital or care home). Around 2% of all admissions with no prior history of MRSA infection or colonization tested positive. Those who were screen positive on admission and not previously known positive were 12 times more likely than those who screened negative to develop infection, increasing to 18 times if they were both screen positive and previously known positive. MRSA infections (7.5 per 1000 inpatient-days overall) also reduced significantly over the study year (P = 0.0209).
The risk factors identified for colonization and infection indicate that a universal clinical risk assessment may have a role in MRSA screening.
一项关于耐甲氧西林金黄色葡萄球菌（MRSA）筛查在苏格兰的有效性的卫生技术评估（HTA）模型表明，使用显色琼脂进行普遍筛查在效果和成本方面是首选。
通过为期一年的试点研究来检验该模型的有效性。
在苏格兰国民保健制度（NHS）的六家急性医院中进行了一项为期一年的大型前瞻性队列研究，共纳入 81438 例住院患者。对结果（MRSA 定植和感染率）进行了多变量分析，并比较了筛查前后的趋势。
初始定植率为 5.5%，到研究第 12 个月下降至 3.5%（P<0.0001）。定植与每位患者的住院次数、入院科室、年龄和入院来源（家庭、其他医院或护理院）有关。约有 2%的所有无既往 MRSA 感染或定植史的住院患者检测结果呈阳性。入院时筛查阳性且既往未知阳性的患者发生感染的可能性是筛查阴性患者的 12 倍，如果他们同时筛查阳性且既往已知阳性，则感染的可能性增加到 18 倍。研究年度内，MRSA 感染（总体每千名住院患者日 7.5 例）也显著减少（P=0.0209）。
确定的定植和感染的危险因素表明，普遍的临床风险评估可能在 MRSA 筛查中发挥作用。
