Seki Masafumi, Takahashi Hiroki, Yamamoto Norihisa, Hamaguchi Shigeto, Ojima Masahiro, Hirose Tomoya, Yoshiya Kazuhisa, Ogura Hiroshi, Shimazu Takeshi, Tomono Kazunori
Division of Infection Control and Prevention, Osaka University Hospital, Suita, Osaka, Japan ; Division of Infection Control and Prevention, Tohoku Pharmaceutical University Hospital, Sendai, Japan.
Department of Traumatology and Acute Critical Medicine, Osaka University Hospital, Suita, Osaka, Japan.
Infect Drug Resist. 2015 May 14;8:113-8. doi: 10.2147/IDR.S80123. eCollection 2015.
Conventional culture methods to detect methicillin-resistant Staphylococcus aureus (MRSA) take a few days, and their sensitivity and usefulness also need to be improved. In this study, active screening was performed using the polymerase chain reaction (PCR) for colonization with MRSA on admission and follow-up surveillance after admission to an emergency department between June 2012 and August 2012, and the backgrounds of PCR and/or culture-method-positive patients were compared. Among 95 patients, 15 (15.8%) patients were positive for MRSA on PCR and/or culture; 6.3% (6/95) of patients were positive on admission, and 9.5% (9/95) became positive during the stay after admission. The major primary diagnoses in MRSA-positive patients were trauma and cerebrovascular diseases. Nine (60%) of 15 patients were MRSA-positive on both PCR and culture, compared with three (20%) of 15 who were PCR-positive but culture-negative. The other three (20%) of 15 patients were PCR-negative but culture-positive. Furthermore, there was a tendency for younger age and shorter stay to be associated with PCR-positive but culture-negative results. These findings suggest that active surveillance with PCR may be highly sensitive and useful for the early diagnosis of MRSA colonization to prevent nosocomial transmission from the emergency department to the regular inpatient wards of the hospital.
传统的检测耐甲氧西林金黄色葡萄球菌（MRSA）的培养方法需要数天时间，其敏感性和实用性也有待提高。在本研究中，于2012年6月至2012年8月期间，对急诊科收治患者入院时采用聚合酶链反应（PCR）进行MRSA定植的主动筛查，并在入院后进行随访监测，比较了PCR和/或培养法检测阳性患者的背景情况。95例患者中，15例（15.8%）患者的MRSA在PCR和/或培养检测中呈阳性；6.3%（6/95）的患者入院时呈阳性，9.5%（9/95）的患者在入院后的住院期间转为阳性。MRSA阳性患者的主要初步诊断为创伤和脑血管疾病。15例患者中有9例（60%）PCR和培养均为MRSA阳性，相比之下，15例中有3例（20%）PCR阳性但培养阴性。另外3例（20%）患者PCR阴性但培养阳性。此外，年龄较小和住院时间较短有与PCR阳性但培养阴性结果相关的趋势。这些发现表明，采用PCR进行主动监测对于早期诊断MRSA定植以预防医院内从急诊科向医院普通住院病房传播可能具有高度敏感性和实用性。
