Intensive Care Unit, Glasgow Royal Infirmary, Glasgow, UK.
Intensive Care Unit, Glasgow Royal Infirmary, Glasgow, UK.
J Hosp Infect. 2015 Aug;90(4):327-32. doi: 10.1016/j.jhin.2015.04.009. Epub 2015 May 1.
Meticillin-resistant Staphylococcus aureus (MRSA) is a common cause of nosocomial infection in the intensive care unit (ICU). A perception exists that ICU-acquired MRSA is associated with poor outcomes, although there are few data to support this.
To determine the effect of acquiring MRSA in the ICU on 180-day mortality, and to identify risk factors associated with acquisition.
Data were collected prospectively from 2007 to 2013. Patients who remained MRSA negative throughout their ICU admission were matched with patients who acquired MRSA in terms of age, Acute Physiology and Chronic Health Evaluation II score, length of ICU stay and surgical/non-surgical status.
In total, 2405 patients were included in the analysis. Patients who acquired MRSA in the ICU had significantly longer ICU stays than patients who were admitted with MRSA and patients who remained MRSA negative throughout their ICU stay (P < 0.001 for both). There were no significant differences in 180-day mortality between the groups (P = 0.238). A confirmed non-MRSA infection within 48 h of ICU admission was associated with increased risk of MRSA acquisition (adjusted odds ratio 2.57, P = 0.005), and receipt of antimicrobial therapy within 48 h of ICU admission was associated with reduced risk of MRSA acquisition (adjusted odds ratio 0.38, P = 0.014).
MRSA acquisition does not contribute towards mortality in critically ill patients. This raises questions regarding the cost-effectiveness of focusing infection prevention measures on the control of MRSA in ICUs. The low acquisition rate and lack of risk factors identified for MRSA in the study cohort indicate that efforts should be directed towards continual improvement of standard infection control procedures for all patients.
耐甲氧西林金黄色葡萄球菌（MRSA）是重症监护病房（ICU）中常见的医院获得性感染病原体。人们普遍认为 ICU 获得性 MRSA 与不良预后相关，但目前仅有少数数据可以支持这一观点。
确定 ICU 获得性 MRSA 对 180 天死亡率的影响，并确定与之相关的危险因素。
数据于 2007 年至 2013 年期间进行前瞻性收集。在整个 ICU 住院期间保持 MRSA 阴性的患者与在 ICU 期间获得 MRSA 的患者（根据年龄、急性生理学和慢性健康评估 II 评分、ICU 住院时间和手术/非手术状态进行匹配）进行匹配。
共纳入 2405 例患者进行分析。在 ICU 获得 MRSA 的患者 ICU 住院时间明显长于入院时即携带 MRSA 的患者和在整个 ICU 住院期间保持 MRSA 阴性的患者（两者均 P<0.001）。各组间 180 天死亡率无显著差异（P=0.238）。在 ICU 入住后 48 小时内确诊的非 MRSA 感染与 MRSA 获得风险增加相关（校正比值比 2.57，P=0.005），而在 ICU 入住后 48 小时内接受抗菌药物治疗与 MRSA 获得风险降低相关（校正比值比 0.38，P=0.014）。
MRSA 获得并不会增加危重症患者的死亡率。这引发了对将感染预防措施的重点放在 ICU 中控制 MRSA 的成本效益的质疑。在研究队列中，MRSA 的低获得率和未确定的危险因素表明，应努力持续改进所有患者的标准感染控制程序。
