Skally Mairéad, Finn Caoimhe, O'Brien David, Fitzpatrick Fidelma, Burns Karen, McFadden Elaine, Fitzpatrick Margaret, Smyth Edmond, Humphreys Hilary
a Department of Clinical Microbiology , Beaumont Hospital , Dublin , Ireland.
b Department of Infection Prevention and Control , Beaumont Hospital , Dublin , Ireland.
Br J Neurosurg. 2017 Jun;31(3):374-378. doi: 10.1080/02688697.2016.1260688. Epub 2017 Jan 3.
Methicillin-resistant Staphylococcus aureus (MRSA) is an important cause of bloodstream infection (BSI), which is declining in many countries, including Ireland. However, it also causes other invasive infections, such as meningitis in neurosurgical patients. It is unclear whether the decline in MRSA BSI is reflected in other invasive infections and in specialist units.
To investigate trends in the incidence of MRSA invasive infection in a national neurosurgical centre over a 10-year period.
A retrospective review of neurosurgical patients with MRSA recovered from sterile sites and indicating invasive infection, according to internationally agreed definitions was conducted between January 2006 and December 2015. Rates per 10,000 bed days used (BDU) and neurosurgical bed days used (NBDU) were calculated and trends were analysed.
Forty-four cases of invasive MRSA infection were identified over the study period. The majority were BSI (26, 59%) followed by ventriculitis (8, 18%). Invasive MRSA infections declined significantly from 0.52 per 10,000 BDU (or 4.65 per 10,000 NBU) in 2006 to 0.22 per 10,000 BDU (or 2.04 per 10,000 NBDU) in 2015, p < .01, despite an increase in neurosurgical clinical activity. Half of the infections occurred in patients with no previous history of MRSA colonisation/infection. The mean length-of-stay for neurosurgical patients with invasive MRSA infections was 67 days (median 32.5 days), significantly greater for other neurosurgical patients (p < .01).
There has been a significant decrease in invasive MRSA infections in neurosurgical patients, reflecting national and international trends for MRSA BSI. This indicates that infection prevention and control measures have been effective in reducing invasive MRSA infections overall, thus contributing to improved patient care.
耐甲氧西林金黄色葡萄球菌（MRSA）是血流感染（BSI）的重要病因，在包括爱尔兰在内的许多国家，其发病率正在下降。然而，它也会引发其他侵袭性感染，如神经外科患者的脑膜炎。目前尚不清楚MRSA血流感染的下降是否反映在其他侵袭性感染以及专科病房中。
调查某国家级神经外科中心10年间MRSA侵袭性感染的发病率趋势。
对2006年1月至2015年12月期间从无菌部位分离出MRSA且表明存在侵袭性感染的神经外科患者进行回顾性研究，研究依据国际公认的定义进行。计算每10000个使用床日（BDU）和每10000个神经外科使用床日（NBDU）的发病率，并分析趋势。
在研究期间共确定了44例侵袭性MRSA感染病例。大多数为血流感染（26例，59%），其次是脑室炎（8例，18%）。侵袭性MRSA感染从2006年的每10000个BDU 0.52例（或每10000个NBU 4.65例）显著下降至2015年的每10000个BDU 0.22例（或每10000个NBDU 2.04例），p < 0.01，尽管神经外科临床活动有所增加。一半的感染发生在既往无MRSA定植/感染史的患者中。侵袭性MRSA感染的神经外科患者平均住院时间为67天（中位数32.5天），显著长于其他神经外科患者（p < 0.01）。
神经外科患者侵袭性MRSA感染显著减少，反映了国家和国际上MRSA血流感染的趋势。这表明感染预防和控制措施在总体上有效减少了侵袭性MRSA感染，从而有助于改善患者护理。
