Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Texas Southwestern, Dallas, Texas.
Division of Pediatric Infectious Diseases, Department of Pediatrics, St. Joseph's Children's Hospital, Paterson, New Jersey.
Am J Perinatol. 2015 May;32(6):531-6. doi: 10.1055/s-0034-1395481. Epub 2014 Dec 29.
To study the impact of methicillin-resistant Staphylococcus aureus (MRSA) surveillance on the incidence of MRSA-related bloodstream infection (BSI) in neonatal intensive care unit (NICU) and to evaluate cost-effectiveness of MRSA surveillance.
MRSA surveillance policy was introduced in our NICU in April 2008. Pre-MRSA surveillance period (P1, April 2006-March 2008) was compared with the surveillance period (P2, April 2008-April 2010) for MRSA-related BSI (MRSA BSI).
During P1 and P2, 1,576 and 1,512 neonates were enrolled. Of these, 3.8/1,000 and 5.3/1,000 developed MRSA BSI, respectively. During P2, 100% MRSA-related BSI occurred in MRSA-colonized neonates, as compared with zero in noncolonized group (p < 0.0001). Overall, 7 (30%) of the 23 neonates colonized during hospitalization developed MRSA BSI as compared with 1 of the 31 (3%) neonates colonized at admission (p = 0.007). Direct screening cost was $208 per patient. Since 28 neonates had to be screened to detect one colonization, $5,824 estimated per detection, excluding indirect costs.
MRSA surveillance may protect non-MRSA colonized neonates from becoming colonized. This is of considerable importance because the acquisition of colonization during hospitalization was associated with a 10-fold increase in risk of developing MRSA BSI. Cost-effectiveness of MRSA surveillance remains debatable and further studies are needed to delineate cost-benefit ratio.
研究耐甲氧西林金黄色葡萄球菌（MRSA）监测对新生儿重症监护病房（NICU）中与 MRSA 相关的血流感染（BSI）发生率的影响，并评估 MRSA 监测的成本效益。
我们的 NICU 于 2008 年 4 月引入了 MRSA 监测政策。将 MRSA 监测前时期（P1，2006 年 4 月至 2008 年 3 月）与监测时期（P2，2008 年 4 月至 2010 年 4 月）进行比较，以评估与 MRSA 相关的 BSI（MRSA BSI）。
在 P1 和 P2 期间，分别有 1576 名和 1512 名新生儿入组。其中，分别有 3.8/1000 和 5.3/1000 发生了 MRSA BSI。在 P2 期间，100%的 MRSA 相关 BSI 发生在 MRSA 定植的新生儿中，而在非定植组中为零（p<0.0001）。总体而言，23 名住院期间定植的新生儿中有 7 名（30%）发生了 MRSA BSI，而 31 名定植于入院时的新生儿中有 1 名（3%）发生了 MRSA BSI（p=0.007）。直接筛查的成本为每位患者 208 美元。由于要检测一个定植，需要筛查 28 名新生儿，估计每次检测的费用为 5824 美元，不包括间接成本。
MRSA 监测可能会保护非 MRSA 定植的新生儿免受定植。这非常重要，因为住院期间的定植与发生 MRSA BSI 的风险增加 10 倍有关。MRSA 监测的成本效益仍存在争议，需要进一步研究以明确成本效益比。
