Obadia Thomas, Opatowski Lulla, Temime Laura, Herrmann Jean-Louis, Fleury Éric, Boëlle Pierre-Yves, Guillemot Didier
1Sorbonne Universités,UPMC Univ Paris 06,UMR_S 1136,Institut Pierre Louis d'Epidémiologie et de Santé Publique,F-75013,Paris,France.
3INSERM,UMR 1181 "Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases" (B2PHI),F-75015 Paris,France.
Infect Control Hosp Epidemiol. 2015 Aug;36(8):922-9. doi: 10.1017/ice.2015.89. Epub 2015 Apr 20.
Reducing the spread of multidrug-resistant bacteria in hospitals remains a challenge. Current methods are screening of patients, isolation, and adherence to hygiene measures among healthcare workers (HCWs). More specific measures could rely on a better characterization of the contacts at risk of dissemination.
To quantify how close-proximity interactions (CPIs) affected Staphylococcus aureus dissemination. DESIGN Nested case-control study.
French long-term care facility in 2009.
Patients (n=329) and HCWs (n=261).
We recorded CPIs using electronic devices together with S. aureus nasal carriage during 4 months in all participants. Cases consisted of patients showing incident S. aureus colonization and were paired to 8 control patients who did not exhibit incident colonization at the same date. Conditional logistic regression was used to quantify associations between incidence and exposure to demographic, network, and carriage covariables.
The local structure of contacts informed on methicillin-resistant S. aureus (MRSA) carriage acquisition: CPIs with more HCWs were associated with incident MRSA colonization in patients (odds ratio [OR], 1.10 [95% CI, 1.04-1.17] for 1 more HCW), as well as longer CPI durations (1.03 [1.01-1.06] for a 1-hour increase). Joint analysis of carriage and contacts showed increased carriage acquisition in case of CPI with another colonized individual (OR, 1.55 [1.14-2.11] for 1 more HCW). Global network measurements did not capture associations between contacts and carriage.
Electronically recorded CPIs inform on the risk of MRSA carriage, warranting more study of in-hospital contact networks to design targeted intervention strategies.
减少医院中耐多药细菌的传播仍然是一项挑战。当前的方法包括对患者进行筛查、隔离以及医护人员遵守卫生措施。更具体的措施可能依赖于对有传播风险的接触进行更好的特征描述。
量化近距离接触（CPls）如何影响金黄色葡萄球菌的传播。设计嵌套病例对照研究。
2009年法国的一家长期护理机构。
患者（n = 329）和医护人员（n = 261）。
我们在4个月内使用电子设备记录了所有参与者的近距离接触情况以及金黄色葡萄球菌鼻腔携带情况。病例包括出现金黄色葡萄球菌新定植的患者，并与8名在同一日期未出现新定植的对照患者配对。使用条件逻辑回归来量化发病率与人口统计学、网络和携带共变量暴露之间的关联。
接触的局部结构提示了耐甲氧西林金黄色葡萄球菌（MRSA）携带获得情况：与更多医护人员的近距离接触与患者发生MRSA新定植相关（每增加1名医护人员，优势比[OR]为1.10 [95%可信区间，1.04 - 1.17]），以及近距离接触持续时间更长（每增加1小时，OR为1.03 [1.01 - 1.06]）。对携带情况和接触情况的联合分析显示，与另一名定植个体进行近距离接触时携带获得增加（每增加1名医护人员，OR为1.55 [1.14 - 2.11]）。全局网络测量未发现接触与携带之间的关联。
电子记录的近距离接触提示了MRSA携带风险，有必要对医院内接触网络进行更多研究以设计针对性的干预策略。
