Barkatali Bilal M, Heywood Nick, White Ruth, Paton Robin W
East Lancashire Hospitals NHS Trust, UK.
Acta Orthop Belg. 2013 Aug;79(4):463-9.
This study aimed at assessing the prevalence of MRSA colonisation in Trauma and Orthopaedics. Risk factors, decolonisation, and subsequent infection rates were investigated. Cost-analysis of the MRSA screening program was performed. The validity and effectiveness of the MRSA screening program was reviewed. A prospective analysis was made of all orthopaedic admissions in East Lancashire Hospital Trust. A total number of 13,155 swabs were taken in 8,867 patients in 2010. This MRSA screening program was compared to the ideal screening criteria set out by Wilson and Junger (WHO 1968). The MRSA prevalence in Trauma and Orthopaedics in 2010 was 0.47%. The decolonisation rate was 55%. There was no correlation between MRSA colonisation and subsequent infection. The total cost of MRSA screening at ELHT was calculated as a minimum of 184,170 Pounds. This could extrapolate to a national expense of around 16 million pounds in England and Wales in Orthopaedics alone. The MRSA screening program did not meet 4 out of 9 screening criteria of Wilson and Junger. The vast majority of Trauma and Orthopaedic patients are not at risk of MRSA colonisation or infection and therefore should not be screened. MRSA infection is a risk in certain high risk groups which should be screened. The MRSA screening program is ineffective when assessed to WHO standards. The program should be considered to be surveillance of MRSA, not an effective screening program for pathological MRSA infection.
本研究旨在评估创伤与骨科领域耐甲氧西林金黄色葡萄球菌（MRSA）定植的患病率。对风险因素、去定植情况及后续感染率进行了调查。开展了MRSA筛查项目的成本分析。对MRSA筛查项目的有效性和效度进行了评估。对东兰开夏郡医院信托基金收治的所有骨科患者进行了前瞻性分析。2010年，共对8867例患者采集了13155份拭子样本。将该MRSA筛查项目与Wilson和Junger（世界卫生组织，1968年）制定的理想筛查标准进行了比较。2010年创伤与骨科领域的MRSA患病率为0.47%。去定植率为55%。MRSA定植与后续感染之间无相关性。东兰开夏郡医院信托基金MRSA筛查的总成本计算为至少184,170英镑。仅在英格兰和威尔士的骨科领域，这可能推算出全国费用约为1600万英镑。MRSA筛查项目未达到Wilson和Junger九项筛查标准中的四项。绝大多数创伤与骨科患者不存在MRSA定植或感染风险，因此不应进行筛查。MRSA感染在某些高危人群中存在风险，应对这些人群进行筛查。按照世界卫生组织的标准评估，MRSA筛查项目无效。该项目应被视为对MRSA的监测，而非针对病理性MRSA感染的有效筛查项目。
