Infection Control Committee, Shimonoseki City Hospital, Shimonoseki, Yamaguchi, Japan.
Infect Drug Resist. 2013 Jul 23;6:59-66. doi: 10.2147/IDR.S45843. Print 2013.
It is not known whether or not ward-specific antimicrobial use density (AUD) affects the ratio of methicillin-resistant Staphylococcus aureus (MRSA) in culture-positive S. aureus. A 60-month study was attempted to ascertain the association between inpatient MRSA ratio and ward-specific AUDs as well as the former and latter study intervals, specimen types, and ward specialty. During the study, the professionals in infection control regulated the use of broad-spectrum antimicrobials and those for MRSA. By both month and ward, the ratio of inpatients positive for MRSA to those positive for S. aureus was calculated. Factors associated with MRSA ratio included AUDs averaged for the sampling month and its previous month, outpatient MRSA ratio by age, ward specialty, specimen type, and half intervals to represent historical changes. Of a total of 4,245 strains of S. aureus isolated during the 5-year study, 2,232 strains (52.6%) were MRSA. By year, outpatient MRSA ratio at age ≥15 decreased in later years, as did inpatient MRSA ratio. Multivariate analysis for inpatient MRSA ratio revealed a positive risk in AUDs for meropenem (odds ratio [OR] 1.761; 95% confidence interval [CI] 1.761-2.637, P = 0.01), imipenem-cilastatin (OR 1.583; 95% CI 1.087-2.306, P = 0.02), ampicillin-sulbactam (OR 1.623; 95% CI 1.114-2.365, P = 0.01), and minocycline (OR 1.680; CI 1.135-2.487, P = 0.01), respiratory care ward (OR 2.292; 95% CI 1.085-4.841, P = 0.03), and outpatient MRSA ratio (OR 1.536; 95% CI 1.070-2.206, P = 0.02). Use of broad-spectrum antimicrobials, such as meropenem, imipenem-cilastatin, and ampicillin-sulbactam may increase inpatient MRSA ratio. Ward factor should be included in MRSA surveillance because of the possible effect on AUD and considering patients' backgrounds.
目前尚不清楚病房特异性抗菌药物使用密度（AUD）是否会影响耐甲氧西林金黄色葡萄球菌（MRSA）在培养阳性金黄色葡萄球菌中的比例。进行了一项为期 60 个月的研究，以确定住院患者 MRSA 比例与病房特异性 AUD 以及前者和后者的研究间隔、标本类型和病房专业之间的关系。在此期间，感染控制专业人员对广谱抗菌药物和 MRSA 抗菌药物的使用进行了调节。通过月份和病房计算出 MRSA 阳性住院患者与金黄色葡萄球菌阳性住院患者的比例。与 MRSA 比值相关的因素包括采样月份及其前一个月的 AUD 平均值、按年龄划分的门诊 MRSA 比值、病房专业、标本类型和半间隔，以代表历史变化。在 5 年的研究中，共分离出 4245 株金黄色葡萄球菌，其中 2232 株（52.6%）为耐甲氧西林金黄色葡萄球菌。按年份划分，≥15 岁门诊患者 MRSA 比值在后期逐年下降，住院患者 MRSA 比值也呈下降趋势。住院患者 MRSA 比值的多变量分析显示，美罗培南（优势比[OR]1.761；95%置信区间[CI]1.761-2.637，P=0.01）、亚胺培南-西司他丁（OR 1.583；95%CI 1.087-2.306，P=0.02）、氨苄西林-舒巴坦（OR 1.623；95%CI 1.114-2.365，P=0.01）和米诺环素（OR 1.680；CI 1.135-2.487，P=0.01）、呼吸科病房（OR 2.292；95%CI 1.085-4.841，P=0.03）和门诊患者 MRSA 比值（OR 1.536；95%CI 1.070-2.206，P=0.02）的 AUD 呈阳性风险。使用美罗培南、亚胺培南-西司他丁和氨苄西林-舒巴坦等广谱抗菌药物可能会增加住院患者的 MRSA 比值。由于病房因素可能会影响 AUD 并考虑患者的背景，因此应将病房因素纳入 MRSA 监测中。
