Hospital das Clínicas da Universidade de São Paulo, Department of Infectious Diseases and LIM-54, São Paulo/SP, Brazil.
Clinics (Sao Paulo). 2011;66(12):2071-7. doi: 10.1590/s1807-59322011001200012.
The aim of this study was to characterize Staphylococcus aureus (MRSA) carriage in a dermatology unit.
This was a prospective and descriptive study. Over the course of 26 weeks, surveillance cultures were collected weekly from the anterior nares and skin of all patients hospitalized in a 20-bed dermatology unit of a tertiary-care hospital. Samples from healthcare workers (HCWS) were cultured at the beginning and end of the study. Colonized patients were put under contact precautions, and basic infection control measures were enforced. Staphylococcus aureus colonization pressure was determined monthly. Colonized and non-colonized patients were compared, and isolates were evaluated for antimicrobial susceptibility, SCCmec type, virulence factors, and type.
Of the 142 patients evaluated, 64 (45%) were colonized by MRSA (39% hospital acquired; 25% community acquired; 36% indeterminate). Despite isolation precautions, hospital-acquired Staphylococcus aureus occurred in addition to the continuous entry of Staphylococcus aureus from the community. Colonization pressure increased from 13% to 59%, and pemphigus and other bullous diseases were associated with MRSA colonization. Eleven out of 71 HCWs (15%) were Staphylococcus aureus carriers, although only one worker carried a persistent clone. Of the hospital-acquired MRSA cases, 14/28 (50%) were SCCmec type IV (3 PFGE types), 13 were SCCmec type III (46%), and one had an indeterminate type. These types were also present among the community-acquired Staphylococcus aureus isolates. SSCmec type IV isolates were shown to be more susceptible than type III isolates. There were two cases of bloodstream infection, and the pvl and tst virulence genes were absent from all isolates.
Dermatology patients were colonized by community- and hospital-acquired Staphylococcus aureus. Half of the nosocomial Staphylococcus aureus isolates were SCCmec type IV. Despite the identification of colonized patients and the subsequent contact precautions and room placement, Staphylococcus aureus colonization continued to occur, and colonization pressure increased. Pemphigus and other bullous diseases were associated with Staphylococcus aureus.
本研究旨在对皮肤科病房的耐甲氧西林金黄色葡萄球菌（MRSA）携带情况进行分析。
本研究为前瞻性描述性研究。在 26 周的时间内，每周从入住一家三级医院 20 张病床皮肤科病房的所有患者的前鼻孔和皮肤采集监测培养样本。在研究开始和结束时，对医护人员（HCWs）的样本进行培养。对定植患者采取接触隔离措施，并强制执行基本感染控制措施。每月确定金黄色葡萄球菌定植压力。比较定植患者和非定植患者，并评估分离株的药敏性、SCCmec 型、毒力因子和型别。
在评估的 142 例患者中，有 64 例（45%）MRSA 定植（39%医院获得性定植；25%社区获得性定植；36%无法确定）。尽管采取了隔离措施，但仍发生了医院获得性金黄色葡萄球菌感染，并且金黄色葡萄球菌持续从社区进入医院。定植压力从 13%上升至 59%，天疱疮和其他大疱性疾病与 MRSA 定植相关。71 名 HCWs 中有 11 名（15%）为金黄色葡萄球菌携带者，尽管只有 1 名工作人员携带持续定植的克隆株。28 例医院获得性 MRSA 中，14 例（50%）为 SCCmec 型 IV（3 种 PFGE 型），13 例为 SCCmec 型 III（46%），1 例为不确定型。这些类型也存在于社区获得性金黄色葡萄球菌分离株中。SCCmec 型 IV 分离株的药敏性比 SCCmec 型 III 分离株更高。发生了 2 例血流感染，所有分离株均未携带 pvl 和 tst 毒力基因。
皮肤科患者被社区获得性和医院获得性金黄色葡萄球菌定植。一半的医院获得性金黄色葡萄球菌分离株为 SCCmec 型 IV。尽管确定了定植患者并随后采取了接触隔离措施和病房安置，但金黄色葡萄球菌定植仍持续发生，定植压力增加。天疱疮和其他大疱性疾病与金黄色葡萄球菌有关。
