全科医生及其患者中的金黄色葡萄球菌，包括耐甲氧西林金黄色葡萄球菌：一项横断面研究。
Staphylococcus aureus, Including Meticillin-Resistant Staphylococcus aureus, among General Practitioners and Their Patients: A Cross-Sectional Study.
作者信息
Michiels Barbara, Appelen Lien, Franck Barbara, den Heijer Casper D J, Bartholomeeusen Stefaan, Coenen Samuel
机构信息
Department of Primary and Interdisciplinary Care Antwerp-Centre for General Practice, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
出版信息
PLoS One. 2015 Oct 12;10(10):e0140045. doi: 10.1371/journal.pone.0140045. eCollection 2015.
BACKGROUND
The role of general practitioners (GPs) as reservoir and potential source for Staphylococcus aureus (SA) transmission is unknown. Our primary objective was to evaluate the prevalence of SA and community-acquired methicillin resistant SA (CA-MRSA) carrier status (including spa typing) among GPs and their patients in Belgium. The secondary objective was to determine the association between SA/CA-MRSA carriage in patients and their characteristics, SA carriage in GPs, GP and practice characteristics.
METHODS
The Belgian GPs, who swabbed their patients in the APRES study (which assessed the prevalence of SA nasal carriage in nine European countries; November 2010 -June 2011), were asked to swab themselves as well (May-June 2011). GPs and their patients had to complete a questionnaire on factors related to SA carriage and transmission. SA isolation including CA-MRSA and spa typing was performed on the swabs.
RESULTS
In eighteen practices 34 GPs swabbed patients of which 25 GPs provided personal swabs. The analysis was performed on 3008 patient records. Among GPs SA carriage (28%) was more prevalent than among their patients (19.2%), but CA-MRSA carriage was not present. SA was more prevalent among younger patients and those living with cattle. Spa typing SA and MRSA strains did not suggest correlation within practices or between patients and GPs, but chronic skin conditions of GPs and always handshaking patients by SA positive GPs were associated with more SA among patients, and hand washing after every patient contact with less SA among patients in practices with high antibiotic prescribing rates.
CONCLUSION
No MRSA was found among GPs, although their SA carriership was higher compared to their patients'. Spa types did not cluster within practices, possibly due to difference in timing of swabbing. To minimise SA transmission to their patients GPs should consider taking appropriate care of their chronic skin diseases, antibiotic prescribing behaviour, handshaking and hand washing habits.
背景
全科医生（GP）作为金黄色葡萄球菌（SA）传播的储存宿主和潜在来源的作用尚不清楚。我们的主要目标是评估比利时全科医生及其患者中SA和社区获得性耐甲氧西林金黄色葡萄球菌（CA-MRSA）携带者状态（包括spa分型）的患病率。次要目标是确定患者中SA/CA-MRSA携带与其特征、全科医生中SA携带、全科医生及执业特征之间的关联。
方法
在APRES研究（评估九个欧洲国家SA鼻腔携带患病率；2010年11月 - 2011年6月）中对患者进行采样的比利时全科医生，也被要求对自己进行采样（2011年5月 - 6月）。全科医生及其患者必须完成一份关于与SA携带和传播相关因素的问卷。对采集的样本进行SA分离，包括CA-MRSA和spa分型。
结果
在18个执业机构中，34名全科医生对患者进行了采样，其中25名全科医生提供了个人样本。对3008份患者记录进行了分析。在全科医生中，SA携带率（28%）高于其患者（19.2%），但未发现CA-MRSA携带。SA在年轻患者和与牛生活在一起的患者中更为普遍。Spa分型的SA和MRSA菌株在执业机构内或患者与全科医生之间未显示出相关性，但全科医生的慢性皮肤状况以及SA阳性全科医生总是与患者握手，与患者中更多的SA相关，而在抗生素处方率高的执业机构中，每次接触患者后洗手，患者中的SA较少。
结论
在全科医生中未发现MRSA，尽管他们的SA携带率高于患者。Spa类型在执业机构内未聚集，可能是由于采样时间的差异。为了尽量减少SA向患者的传播，全科医生应考虑妥善处理他们的慢性皮肤病、抗生素处方行为、握手和洗手习惯。
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