Nuemi G, Astruc K, Aho S, Quantin C
Service de biostatistique et d'informatique médicale, CHU de Dijon, CHRU, 21000 Dijon, France.
Rev Epidemiol Sante Publique. 2013 Oct;61(5):455-61. doi: 10.1016/j.respe.2013.04.008. Epub 2013 Aug 29.
The surveillance of methicillin-resistant Staphylococcus aureus (MRSA) is a national priority. The rate of MRSA infections is one of six indicators tracked by the Department of Health. Since 2002, the French institute for public health surveillance (InVS) has monitored MRSA infections to estimate incidence density. Today, the use of the French administrative database (PMSI) could facilitate this surveillance. The aim of this study was to compare MRSA incidence density computed at a national level using PMSI databases with the results from the InVS taken as the reference.
PMSI databases for the years 2006 to 2009 were used. The reference results were those published by the InVS from 2006 to 2009. MRSA density defined as the number of MRSA infections recorded per year over 1000 hospital stays was computed. It was then compared with the MRSA incidence density measured by InVS. The time course of MRSA incidence in the PMSI records was modeled using a Poisson regression.
The incidence density measured by the InVS was higher than the MRSA density computed using the PMSI, but this difference appeared to decrease over time. The PMSI density/InVS MRSA incidence density ratio was 0.8% in 2006 and about 9.2% in 2009. We observed inverted trends with a growing trend in MRSA density identified by the PMSI. Furthermore, the year of study was significantly associated with incidence density (P=0.01).
Using PMSI data as an additional source of information in the hospital MRSA surveillance process makes it possible to detect and analyze patient repeats at the regional and national levels with linkage facilities. Estimation of incidence density for hospitals not participating to this surveillance system will be the next step.
耐甲氧西林金黄色葡萄球菌（MRSA）监测是一项国家重点工作。MRSA感染率是卫生部追踪的六项指标之一。自2002年以来，法国公共卫生监测研究所（InVS）一直对MRSA感染进行监测，以估算发病密度。如今，使用法国行政数据库（PMSI）有助于开展此项监测。本研究旨在比较使用PMSI数据库在国家层面计算得出的MRSA发病密度与以InVS结果为参照得出的结果。
使用2006年至2009年的PMSI数据库。参照结果为InVS在2006年至2009年公布的结果。计算出MRSA密度，即每年每1000次住院记录的MRSA感染数量。然后将其与InVS测得的MRSA发病密度进行比较。使用泊松回归对PMSI记录中MRSA发病的时间进程进行建模。
InVS测得的发病密度高于使用PMSI计算得出的MRSA密度，但这种差异似乎随时间推移而减小。2006年PMSI密度/InVS MRSA发病密度之比为0.8%，2009年约为9.2%。我们观察到相反的趋势，PMSI确定的MRSA密度呈上升趋势。此外，研究年份与发病密度显著相关（P = 0.01）。
在医院MRSA监测过程中，将PMSI数据用作额外信息来源，借助关联设施能够在区域和国家层面检测并分析患者复诊情况。下一步将是对未参与该监测系统的医院的发病密度进行估算。
