Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China.
BMC Infect Dis. 2013 May 6;13:205. doi: 10.1186/1471-2334-13-205.
The relative contribution of long term care facilities (LTCFs) and hospitals in the transmission of methicillin-resistant Staphylococcus aureus (MRSA) is unknown.
Concurrent MRSA screening and spa type analysis was performed in LTCFs and their network hospitals to estimate the rate of MRSA acquisition among residents during their stay in LTCFs and hospitals, by colonization pressure and MRSA transmission calculations.
In 40 LTCFs, 436 (21.6%) of 2020 residents were identified as 'MRSA-positive'. The incidence of MRSA transmission per 1000-colonization-days among the residents during their stay in LTCFs and hospitals were 309 and 113 respectively, while the colonization pressure in LTCFs and hospitals were 210 and 185 per 1000-patient-days respectively. MRSA spa type t1081 was the most commonly isolated linage in both LTCF residents (76/121, 62.8%) and hospitalized patients (51/87, 58.6%), while type t4677 was significantly associated with LTCF residents (24/121, 19.8%) compared with hospitalized patients (3/87, 3.4%) (p<0.001). This suggested continuous transmission of MRSA t4677 among LTCF residents. Also, an inverse linear relationship between MRSA prevalence in LTCFs and the average living area per LTCF resident was observed (Pearson correlation -0.443, p=0.004), with the odds of patients acquiring MRSA reduced by a factor of 0.90 for each 10 square feet increase in living area.
Our data suggest that MRSA transmission was more serious in LTCFs than in hospitals. Infection control should be focused on LTCFs in order to reduce the burden of MRSA carriers in healthcare settings.
长期护理机构（LTCFs）和医院在耐甲氧西林金黄色葡萄球菌（MRSA）传播中的相对贡献尚不清楚。
对 LTCFs 及其网络医院同时进行 MRSA 筛查和 spa 型分析，通过定植压力和 MRSA 传播计算来估计居民在 LTCFs 和医院住院期间获得 MRSA 的比率。
在 40 家 LTCFs 中，2020 名居民中有 436 人（21.6%）被确定为“MRSA 阳性”。居民在 LTCFs 和医院住院期间每 1000 天定植天数的 MRSA 传播发生率分别为 309 和 113，而 LTCFs 和医院的定植压力分别为每 1000 名患者 210 和 185 天。t1081 型 spa 是 LTCF 居民（76/121，62.8%）和住院患者（51/87，58.6%）中最常见的分离株，而 t4677 型与 LTCF 居民（24/121，19.8%）显著相关，而与住院患者（3/87，3.4%）相比（p<0.001）。这表明 MRSA t4677 在 LTCF 居民中持续传播。此外，还观察到 LTCFs 中 MRSA 流行率与每个 LTCF 居民平均居住面积之间呈负线性关系（皮尔逊相关系数-0.443，p=0.004），居住面积每增加 10 平方英尺，患者获得 MRSA 的几率就会降低 0.90 倍。
我们的数据表明，MRSA 在 LTCFs 中的传播比在医院更为严重。感染控制应侧重于 LTCFs，以减少医疗机构中 MRSA 携带者的负担。
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