Shankar Nivedita, Chow Angela Li Ping, Oon Jolene, Hsu Li Yang, Ang Brenda, Pang Junxiong, De Sessions Paola Florez, Periaswamy Balamurugan, Tambyah Paul A, Teo Desmond B, Tam Clarence C
Saw Swee Hock School of Public Health, Tahir Foundation Building, 12 Science Drive 2, 11-01, Singapore, 117549, Singapore.
Tan Tock Seng Hospital, Singapore, Singapore.
BMC Infect Dis. 2017 Oct 11;17(1):678. doi: 10.1186/s12879-017-2793-y.
BACKGROUND/AIM: Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most common multidrug-resistant organisms in healthcare settings worldwide, but little is known about MRSA transmission outside of acute healthcare settings especially in Asia. We describe the methods for a prospective longitudinal study of MRSA prevalence and transmission.
MRSA-colonized individuals were identified from MRSA admission screening at two tertiary hospitals and recruited together with their household contacts. Participants submitted self-collected nasal, axilla and groin (NAG) swabs by mail for MRSA culture at baseline and monthly thereafter for 6 months. A comparison group of households of MRSA-negative patients provided swab samples at one time point. In a validation sub-study, separate swabs from each site were collected from randomly selected individuals, to compare MRSA detection rates between swab sites, and between samples collected by participants versus those collected by trained research staff. Information on each participant's demographic information, medical status and medical history, past healthcare facilities usage and contacts, and personal interactions with others were collected using a self-administered questionnaire.
DISCUSSION/CONCLUSION: Understanding the dynamics of MRSA persistence and transmission in the community is crucial to devising and evaluating successful MRSA control strategies. Close contact with MRSA colonized patients may to be important for MRSA persistence in the community; evidence from this study on the extent of community MRSA could inform the development of household- or community-based interventions to reduce MRSA colonization of close contacts and subsequent re-introduction of MRSA into healthcare settings. Analysis of longitudinal data using whole-genome sequencing will yield further information regarding MRSA transmission within households, with significant implications for MRSA infection control outside acute hospital settings.
背景/目的：耐甲氧西林金黄色葡萄球菌（MRSA）是全球医疗机构中最常见的多重耐药菌之一，但对于急性医疗机构以外尤其是亚洲地区的MRSA传播情况，人们了解甚少。我们描述了一项关于MRSA患病率及传播的前瞻性纵向研究方法。
从两家三级医院的MRSA入院筛查中识别出MRSA定植个体，并招募其家庭接触者。参与者在基线时通过邮件提交自行采集的鼻腔、腋窝和腹股沟（NAG）拭子进行MRSA培养，此后每月一次，共6个月。一组MRSA阴性患者的家庭作为对照组，在一个时间点提供拭子样本。在一项验证性子研究中，从随机选择的个体中分别采集每个部位的拭子，以比较不同拭子部位之间以及参与者采集的样本与经过培训的研究人员采集的样本之间的MRSA检测率。使用自填问卷收集每位参与者的人口统计学信息、医疗状况和病史、过去使用医疗设施的情况及接触情况，以及与他人的个人互动信息。
讨论/结论：了解社区中MRSA持续存在和传播的动态对于制定和评估成功的MRSA控制策略至关重要。与MRSA定植患者的密切接触可能对社区中MRSA的持续存在很重要；本研究关于社区MRSA程度的证据可为制定基于家庭或社区的干预措施提供参考，以减少密切接触者的MRSA定植以及随后MRSA再次引入医疗机构的情况。使用全基因组测序分析纵向数据将产生关于家庭内MRSA传播的更多信息，对急性医院环境以外的MRSA感染控制具有重要意义。
