Department of Medicine, University of Chicago, Chicago, Illinois 60637, USA.
Infect Control Hosp Epidemiol. 2012 Aug;33(8):782-9. doi: 10.1086/666640. Epub 2012 Jun 11.
The incidence of invasive methicillin-resistant Staphylococcus aureus (MRSA) infections in the United States decreased during 2005-2008, but noninvasive community-associated MRSA (CA-MRSA) infections also frequently lead to hospitalization. We estimated the incidence of all MRSA infections among inpatients at US academic medical centers (AMCs) per 1,000 admissions during 2003-2008.
Retrospective cohort study.
Hospitalized patients at 90% of nonprofit US AMCs during 2003-2008.
Administrative data on MRSA infections from a hospital discharge database (University HealthSystem Consortium [UHC]) were adjusted for underreporting of the MRSA V09.0 International Classification of Diseases, Ninth Revision, Clinical Modification code and validated using chart reviews for patients with known MRSA infections in 2004-2005, 2006, and 2007.
The mean sensitivity of administrative data for MRSA infections at the University of Chicago Medical Center in three 12-month periods during 2004-2007 was 59.1%. On the basis of estimates of billing data sensitivity from the literature and the University of Chicago Medical Center, the number of MRSA infections per 1,000 hospital discharges at US AMCs increased from 20.9 (range, 11.1-47.7) in 2003 to 41.7 (range, 21.9-94.0) in 2008. At the University of Chicago Medical Center, among infections cultured more than 3 days prior to hospital discharge, CA-MRSA infections were more likely to be captured in the UHC billing-derived data than were healthcare-associated MRSA infections.
The number of hospital admissions for any MRSA infection per 1,000 hospital admissions overall increased during 2003-2008. Use of unadjusted administrative hospital discharge data or surveillance for invasive disease far underestimates the number of MRSA infections among hospitalized patients.
2005 年至 2008 年期间，美国侵袭性耐甲氧西林金黄色葡萄球菌（MRSA）感染的发病率有所下降，但非侵袭性社区相关性 MRSA（CA-MRSA）感染也经常导致住院。我们估计了 2003 年至 2008 年期间美国学术医疗中心（AMC）每 1000 例住院患者中所有 MRSA 感染的发病率。
回顾性队列研究。
2003 年至 2008 年期间，90%的非营利性美国 AMC 住院患者。
从医院出院数据库（大学健康联盟 [UHC]）获取的 MRSA 感染的行政数据，根据 MRSA V09.0 国际疾病分类，第九修订版，临床修正代码的报告不足进行了调整，并对 2004-2005 年、2006 年和 2007 年已知有 MRSA 感染的患者的图表进行了回顾性验证。
在 2004-2007 年的三个 12 个月期间，芝加哥大学医疗中心行政数据对 MRSA 感染的平均灵敏度为 59.1%。根据文献和芝加哥大学医疗中心计费数据灵敏度的估计，美国 AMC 每 1000 例出院患者的 MRSA 感染人数从 2003 年的 20.9（范围 11.1-47.7）增加到 2008 年的 41.7（范围 21.9-94.0）。在芝加哥大学医疗中心，对于在出院前超过 3 天培养的感染，CA-MRSA 感染比与医疗保健相关的 MRSA 感染更有可能被 UHC 计费数据捕获。
2003 年至 2008 年期间，每 1000 例住院患者中任何 MRSA 感染的住院人数增加。使用未经调整的行政医院出院数据或对侵袭性疾病的监测大大低估了住院患者中 MRSA 感染的数量。
