Infectious Diseases Division, Rhode Island Hospital, Providence, Rhode Island; and Warren Alpert Medical School of Brown University, Providence, Rhode Island.
Pediatrics. 2014 Apr;133(4):e1015-23. doi: 10.1542/peds.2013-3413. Epub 2014 Mar 10.
Methicillin-resistant Staphylococcus aureus (MRSA) is a significant cause of morbidity and mortality in NICUs and PICUs. Our objective was to assess the burden of MRSA colonization on admission, study the time trends, and examine the significance of MRSA colonization in this population.
PubMed and Embase databases were consulted. Studies that reported prevalence of MRSA colonization on ICU admission were selected. Two authors independently extracted data on MRSA colonization and infection.
We identified 18 suitable articles and found an overall prevalence of MRSA colonization of 1.9% (95% confidence interval [CI] 1.3%-2.6%) on admission to the NICU or PICU, with a stable trend over the past 12 years. Interestingly, 5.8% (95% CI 1.9%-11.4%) of outborn neonates were colonized with MRSA on admission to NICU, compared with just 0.2% (95% CI 0.0%-0.9%) of inborn neonates (P = .01). The pooled acquisition rate of MRSA colonization was 4.1% (95% CI 1.2%-8.6%) during the NICU and PICU stay and was as high as 6.1% (95% CI 2.8%-10.6%) when the NICU population was studied alone. There was a relative risk of 24.2 (95% CI 8.9-66.0) for colonized patients to develop a MRSA infection during hospitalization.
In the NICU and PICU, there are carriers of MRSA on admission, and MRSA colonization in the NICU is almost exclusively associated with outborn neonates. Importantly, despite infection control measures, the acquisition rate is high, and patients colonized with MRSA on admission are more likely to suffer a MRSA infection during hospitalization.
耐甲氧西林金黄色葡萄球菌（MRSA）是新生儿重症监护病房（NICU）和儿科重症监护病房（PICU）发病率和死亡率的重要原因。我们的目的是评估 MRSA 定植在入院时的负担，研究时间趋势，并检验该人群中 MRSA 定植的意义。
检索 PubMed 和 Embase 数据库。选择报告 ICU 入院时 MRSA 定植流行率的研究。两名作者独立提取关于 MRSA 定植和感染的数据。
我们确定了 18 篇合适的文章，发现 NICU 或 PICU 入院时 MRSA 定植的总体流行率为 1.9%（95%置信区间[CI]1.3%-2.6%），过去 12 年呈稳定趋势。有趣的是，5.8%（95%CI1.9%-11.4%）的外来新生儿在 NICU 入院时定植了 MRSA，而仅 0.2%（95%CI0.0%-0.9%）的本地新生儿定植了 MRSA（P=0.01）。NICU 和 PICU 住院期间，MRSA 定植的累积获得率为 4.1%（95%CI1.2%-8.6%），当单独研究 NICU 人群时，这一比例高达 6.1%（95%CI2.8%-10.6%）。定植患者在住院期间发生 MRSA 感染的相对风险为 24.2（95%CI8.9-66.0）。
在 NICU 和 PICU 中，入院时就有 MRSA 携带者，NICU 中的 MRSA 定植几乎完全与外来新生儿有关。重要的是，尽管采取了感染控制措施，但获得率仍然很高，入院时定植 MRSA 的患者在住院期间更有可能发生 MRSA 感染。
