Vendrell E, Capdevila J A, Barrufet P, Force L, Sauca G, Martínez E, Palomera E, Serra-Prat M, Cornudella J, Llopis A, Robledo M A, Vázquez C
Josep Anton Capdevila Morell, Internal Medicine Unit. Hospital de Mataró. Ctra. Cirera, s/n. Mataró, 08304 Barcelona, Spain.
Rev Esp Quimioter. 2015 Apr;28(2):92-7.
Little is known about the natural course of patients with chronic stable illnesses colonized with methicillin-resistant Staphylococcus aureus (MRSA). The aim is to determine the impact of MRSA colonization in mortality among long-term health care facility (LTHCF) residents.
A multicenter, prospective, observational study was designed. Residents in 4 LTHCFs were classified according to MRSA carriage status and followed for 12 months. Treatment consisted of 5 days of nasal mupirocin in MRSA carriers.
Ninety-three MRSA-carriers among 413 residents were identified. Thirty-one MRSA-colonized patients died during the study period, 11 of whom from an infectious disease. Independent predictors of their higher mortality rates included heart failure, current neoplasm, MRSA carriage and COPD at 3 months and these same factors plus stroke, Bar-thel index <40, pressure ulcers, and older age at 12 months. MRSA-persistence was 35% and 62.5% at 3 and 12 months, respectively.
MRSA colonization among frail LTHCFs residents is highly prevalent, and is associated with higher mortality. Despite treatment of MRSA carriers, many remained colonized. Factors that promote persistence of MRSA colonization, and the impact of their modification on mortality rates in these patients, need further investigation.
对于长期携带耐甲氧西林金黄色葡萄球菌（MRSA）的慢性稳定疾病患者的自然病程，我们了解甚少。本研究旨在确定MRSA定植对长期医疗保健机构（LTHCF）居民死亡率的影响。
设计了一项多中心、前瞻性观察性研究。4家LTHCF的居民根据MRSA携带状况进行分类，并随访12个月。对MRSA携带者进行为期5天的鼻用莫匹罗星治疗。
在413名居民中识别出93名MRSA携带者。31名MRSA定植患者在研究期间死亡，其中11人死于传染病。其较高死亡率的独立预测因素包括心力衰竭、当前肿瘤、3个月时的MRSA携带和慢性阻塞性肺疾病（COPD），以及这些相同因素加上中风、巴氏指数<40、压疮和12个月时的高龄。MRSA持续携带率在3个月和12个月时分别为35%和62.5%。
体弱的LTHCF居民中MRSA定植非常普遍，且与较高死亡率相关。尽管对MRSA携带者进行了治疗，但许多人仍持续定植。促进MRSA定植持续存在的因素及其改变对这些患者死亡率的影响，需要进一步研究。
