Institute of Hygiene and Environmental Medicine Charité-University Hospital Berlin, Hindenburgdamm 27, 12203 Berlin, Germany.
Antimicrob Resist Infect Control. 2012 Feb 13;1(1):8. doi: 10.1186/2047-2994-1-8.
Two MRSA surveillance components exist within the German national nosocomial infection surveillance system KISS: one for the whole hospital (i.e. only hospital based data and no rates for individual units) and one for ICU-based data (rates for each individual ICU). The objective of this study was to analyze which surveillance system (a hospital based or a unit based) leads to a greater decrease in incidence density of nosocomial MRSA METHODS: Two cohort studies of surveillance data were used: Data from a total of 224 hospitals and 359 ICUs in the period from 2004 to 2009. Development over time was described first for both surveillance systems. In a second step only data were analyzed from those hospitals/ICUs with continuous participation for at least four years. Incidence rate ratios (IRR) with 95% confidence intervals were calculated to compare incidence densities between different time intervals.
In the baseline year the mean MRSA incidence density of hospital acquired MRSA cases was 0.25 and the mean incidence density of ICU-acquired MRSA was 1.25 per 1000 patient days. No decrease in hospital-acquired MRSA rates was found in a total of 111 hospitals with continuous participation in the hospital- based system. However, in 159 ICUs with continuous participation in the unit-based system, a significant decrease of 29% in ICU-acquired MRSA was identified.
A unit-based approach of surveillance and feedback seems to be more successful in decreasing nosocomial MRSA rates, compared to a hospital-based approach. Therefore each surveillance system should provide unit-based data to stimulate activities on the unit level.
德国国家院内感染监测系统 KISS 中存在两种 MRSA 监测组件：一种用于整个医院（即仅基于医院的数据，而没有针对各个科室的发病率），另一种用于 ICU 数据（每个 ICU 的发病率）。本研究的目的是分析哪种监测系统（基于医院的还是基于科室的）会导致医院获得性耐甲氧西林金黄色葡萄球菌（MRSA）的发病率密度下降更大。
本研究使用了两项监测数据的队列研究：2004 年至 2009 年期间共有 224 家医院和 359 家 ICU 的数据。首先描述了这两种监测系统的随时间的发展情况。在第二步中，仅分析那些至少连续四年参与的医院/ICU 的数据。计算发病率比值（IRR）及其 95%置信区间，以比较不同时间段的发病率密度。
在基线年份，医院获得性 MRSA 病例的平均 MRSA 发病率密度为 0.25，ICU 获得性 MRSA 的平均发病率密度为每 1000 个患者日 1.25。在总共 111 家连续参与基于医院的系统的医院中，未发现医院获得性 MRSA 率下降。然而，在连续参与基于科室的系统的 159 家 ICU 中，发现 ICU 获得性 MRSA 显著下降 29%。
与基于医院的方法相比，基于科室的监测和反馈方法似乎更能成功降低医院获得性 MRSA 率。因此，每个监测系统都应该提供基于科室的数据，以刺激科室层面的活动。
