McManus A T, Mason A D, McManus W F, Pruitt B A
US Army Institute of Surgical Research, Fort Sam Houston, San Antonio, Tex. 78234-5012.
Arch Surg. 1989 Dec;124(12):1456-9. doi: 10.1001/archsurg.1989.01410120106020.
Methicillin-resistant Staphylococcus aureus (MRSA) strains, principally resistant to penicillinase-resistant penicillins and aminoglycosides, are increasingly common hospital isolates. We have examined the significance of MRSA colonization and infection in 1100 consecutively admitted, seriously burned patients in whom vancomycin was used to treat all staphylococcal infections. Colonization with S aureus (SA) was identified in 658 patients, in 319 of whom MRSA colonization was identified. Two hundred fifty-three SA infections occurred in 178 patients; of these infections, 58% were pulmonic and 38% were bacteremic. Methicillin-resistant SA infections occurred in 58 of the SA-infected patients. A severity index, based on multiple-regression analysis of mortality as a function of burn size and age in the study population, was used to estimate expected mortality. We demonstrated no measurable increase in mortality attributable to MRSA in this population of burned, SA-infected patients. The results question the clinical and economic value of added control practices, such as closing of units, refusal of transfer or admission, added isolation, treatment of carriers, furlough of colonized staff, and other expensive measures that are specifically directed at prevention of MRSA infections in critical care areas.
耐甲氧西林金黄色葡萄球菌（MRSA）菌株主要对耐青霉素酶的青霉素和氨基糖苷类耐药，是医院中越来越常见的分离菌株。我们对1100例连续收治的严重烧伤患者进行了研究，这些患者均使用万古霉素治疗所有葡萄球菌感染，以考察MRSA定植和感染的意义。658例患者被鉴定为金黄色葡萄球菌（SA）定植，其中319例鉴定为MRSA定植。178例患者发生了253次SA感染；在这些感染中，58%为肺部感染，38%为菌血症。58例SA感染患者发生了耐甲氧西林SA感染。根据对研究人群中死亡率作为烧伤面积和年龄函数的多元回归分析得出的严重程度指数，用于估计预期死亡率。我们证明，在这群烧伤且SA感染的患者中，MRSA所致死亡率没有可测量的增加。这些结果对额外控制措施的临床和经济价值提出了质疑，这些措施包括关闭病房、拒绝转院或入院、加强隔离、治疗携带者、让定植工作人员休假以及其他专门针对重症监护病房预防MRSA感染的昂贵措施。
