Wu P J, Jeyaratnam D, Tosas O, Cooper B S, French G L
Department of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Department of Microbiology, King's College Hospital NHS Foundation Trust, London, UK.
J Hosp Infect. 2017 Mar;95(3):245-252. doi: 10.1016/j.jhin.2016.08.017. Epub 2016 Aug 24.
Meticillin-resistant Staphylococcus aureus (MRSA) is frequently endemic in healthcare settings and may be transmitted by person-to-person spread. Asymptomatic MRSA carriers are potential, unsuspected sources for transmission and some of them may be identified by admission screening.
To assess whether rapid point-of-care screening (POCS) for MRSA at hospital admission may be associated with a reduction in MRSA acquisition rates when compared with slower laboratory-based methods.
A cluster-randomized cross-over trial was conducted in four admission wards of an acute London tertiary care hospital. Polymerase chain reaction-based POCS screening was compared with conventional culture screening. Patients were screened on ward admission and discharge, and the MRSA acquisition rate on the admission wards was calculated as the primary outcome measure.
In all, 10,017 patients were included; 4978 in the control arm, 5039 in the POCS arm. The MRSA carriage rate on admission was 1.7%. POCS reduced the median reporting time from 40.4 to 3.7 h (P < 0.001). MRSA was acquired on the admission wards by 23 (0.46%) patients in the control arm and by 24 (0.48%) in the intervention arm, acquisition rates of 5.39 and 4.60 per 1000 days respectively. After taking account of predefined confounding factors, the adjusted incidence rate ratio (IRR) for change in trend for MRSA acquisition was 0.961 (95% confidence interval: 0.766-1.206). The adjusted IRR for step change for MRSA acquisition was 0.98 (0.304-3.162).
POCS produces a significantly faster result but has no effect on MRSA acquisition on admission wards compared with culture screening. Where compliance with infection prevention and control is high and MRSA carriage is low, POCS has no additional impact on MRSA acquisition rates over the first one to four days of admission compared with conventional culture screening.
耐甲氧西林金黄色葡萄球菌（MRSA）在医疗机构中常呈地方性流行，且可能通过人际传播。无症状的MRSA携带者是潜在的、未被怀疑的传播源，其中一些可通过入院筛查发现。
评估与基于实验室的较慢方法相比，在医院入院时对MRSA进行快速即时检测（POCS）是否可降低MRSA感染率。
在伦敦一家急性三级护理医院的四个入院病房进行了一项整群随机交叉试验。将基于聚合酶链反应的POCS筛查与传统培养筛查进行比较。在患者入院和出院时进行筛查，并将入院病房的MRSA感染率作为主要结局指标进行计算。
共纳入10017例患者；对照组4978例，POCS组5039例。入院时MRSA携带率为1.7%。POCS将中位报告时间从40.4小时缩短至3.7小时（P<0.001）。对照组有23例（0.46%）患者在入院病房感染MRSA，干预组有24例（0.48%），感染率分别为每1000天5.39例和4.60例。在考虑了预定义的混杂因素后，MRSA感染趋势变化的调整发病率比（IRR）为0.961（95%置信区间：0.766-1.206）。MRSA感染阶跃变化的调整IRR为0.98（0.304-3.162）。
与培养筛查相比，POCS检测结果显著更快，但对入院病房的MRSA感染没有影响。在感染预防与控制依从性高且MRSA携带率低的情况下，与传统培养筛查相比，POCS在入院的头1至4天对MRSA感染率没有额外影响。
