1Department of Epidemiology,Biostatistics and Occupational Health,McGill University.
2Direction des risques biologiques et de la santé au travail,Institut national de santé publique du Québec.
Infect Control Hosp Epidemiol. 2017 Jul;38(7):840-847. doi: 10.1017/ice.2017.81. Epub 2017 Jun 5.
OBJECTIVE We examined the impact of methicillin-resistant Staphylococcus aureus (MRSA) guidelines in Québec adult hospitals from January 1, 2006, to March 31, 2015, by examining the incidence rate reduction (IRR) in healthcare-associated MRSA bloodstream infections (HA-MRSA), using central-line associated bloodstream infections (CLABSIs) as a comparator. METHODS In this study, we utilized a quasi-experimental design with Poisson segmented regression to model HA-MRSA and CLABSI incidence for successive 4-week surveillance segments, stratified by teaching status. We used 3 distinct periods with 2 break points (April 1, 2007, and January 3, 2010) corresponding to major MRSA guideline publications and updates. RESULTS Over the study period, HA-MRSA incidence decreased significantly in adult teaching facilities but not in nonteaching facilities. Prior to MRSA guideline publication (2006-2007), HA-MRSA incidence decrease was not significant (P=.89), while CLABSI incidence decreased by 4% per 4-week period (P=.05). After the publication of guidelines (2007-2009), HA-MRSA incidence decreased significantly by 1% (P=.04), while no significant decrease in CLABSI incidence was observed (P=.75). HA-MRSA and CLABSI decreases were both significant at 1% for 2010-2015 (P<.001 and P=.01, respectively). These decreases were gradual rather than sudden; break points were not significant. Teaching facilities drove these decreases. CONCLUSION During the study period, HA-MRSA and CLABSI rates decreased significantly. In 2007-2009, the significant decrease in HA-MRSA rates with stable CLABSI rates suggests an impact from MRSA-specific guidelines. In 2010-2015, significant and equal IRRs for HA-MRSA and CLABSI may be due to the continuing impact of MRSA guidelines, to the impact of new interventions targeting device-associated infections in general by the 2010-2015 Action Plan, or to a combination of factors. Infect Control Hosp Epidemiol 2017;38:840-847.
我们通过比较与中心静脉导管相关的血流感染（CLABSI），研究了 2006 年 1 月 1 日至 2015 年 3 月 31 日期间魁北克成人医院耐甲氧西林金黄色葡萄球菌（MRSA）指南对医源性 MRSA 血流感染（HA-MRSA）发病率降低（IRR）的影响。
本研究采用准实验设计，使用泊松分段回归模型对连续 4 周的监测段进行 HA-MRSA 和 CLABSI 发病率建模，分层因素为教学状态。我们使用了 3 个不同的时间段和 2 个断点（2007 年 4 月 1 日和 2010 年 1 月 3 日），分别对应主要的 MRSA 指南发布和更新。
在研究期间，成人教学医院的 HA-MRSA 发病率显著下降，但非教学医院则没有。在 MRSA 指南发布之前（2006-2007 年），HA-MRSA 发病率下降不显著（P=.89），而每 4 周 CLABSI 发病率下降 4%（P=.05）。指南发布后（2007-2009 年），HA-MRSA 发病率显著下降 1%（P=.04），而 CLABSI 发病率无显著下降（P=.75）。2010-2015 年，HA-MRSA 和 CLABSI 分别下降 1%（P<.001 和 P=.01），均有统计学意义。这些下降是逐渐的，而不是突然的；断点不显著。教学医院推动了这些下降。
在研究期间，HA-MRSA 和 CLABSI 率显著下降。在 2007-2009 年，HA-MRSA 发病率显著下降，而 CLABSI 发病率稳定，这表明 MRSA 特异性指南产生了影响。在 2010-2015 年，HA-MRSA 和 CLABSI 的发病率降低率相似，可能是由于 MRSA 指南的持续影响，也可能是由于 2010-2015 年行动计划针对器械相关感染的新干预措施的影响，或者是多种因素的综合作用。
