Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, King's College London and Guy's and St Thomas' NHS Foundation Trust.
Oxford Health Systems Collaboration, Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford.
Clin Infect Dis. 2018 Mar 5;66(6):840-848. doi: 10.1093/cid/cix901.
Recent evidence suggests that hospital transmission of methicillin-resistant Staphylococcus aureus (MRSA) is uncommon in UK centers that have implemented sustained infection control programs. We investigated whether a healthcare-network analysis could shed light on transmission paths currently sustaining MRSA levels in UK hospitals.
A cross-sectional observational study was performed in 2 National Health Service hospital groups and a general district hospital in Southeast London. All MRSA patients identified at inpatient, outpatient, and community settings between 1 November 2011 and 29 February 2012 were included. We identified genetically defined MRSA transmission clusters in individual hospitals and across the healthcare network, and examined genetic differentiation of sequence type (ST) 22 MRSA isolates within and between hospitals and inpatient or outpatient and community settings, as informed by average and median pairwise single-nucleotide polymorphisms (SNPs) and SNP-based proportions of nearly identical isolates.
Two hundred forty-eight of 610 (40.7%) MRSA patients were linked in 90 transmission clusters, of which 27 spanned multiple hospitals. Analysis of a large 32 patient ST22-MRSA cluster showed that 26 of 32 patients (81.3%) had multiple contacts with one another during ward stays at any hospital. No residential, outpatient, or significant community healthcare contacts were identified. Genetic differentiation between ST22 MRSA inpatient isolates from different hospitals was less than between inpatient isolates from the same hospitals (P ≤ .01).
There is evidence of frequent ward-based transmission of MRSA brought about by frequent patient admissions to multiple hospitals. Limiting in-ward transmission requires sharing of MRSA status data between hospitals.
最近的证据表明，在英国实施了持续感染控制计划的中心，耐甲氧西林金黄色葡萄球菌（MRSA）的医院传播并不常见。我们调查了医疗保健网络分析是否可以阐明目前在英国医院维持 MRSA 水平的传播途径。
在伦敦东南部的 2 个国民保健服务医院组和一个普通地区医院进行了横断面观察性研究。在 2011 年 11 月 1 日至 2012 年 2 月 29 日期间，在住院、门诊和社区环境中发现的所有 MRSA 患者均被纳入研究。我们在各个医院和整个医疗保健网络中确定了遗传定义的 MRSA 传播群集，并根据平均和中位数单核苷酸多态性（SNP）以及基于 SNP 的近乎相同分离株的比例，检查了医院内和医院间 ST22 型 MRSA 分离株的遗传分化，以及住院或门诊和社区环境中的 ST22 型 MRSA 分离株的遗传分化。
在 610 例 MRSA 患者中有 248 例（40.7%）被 90 个传播群集联系在一起，其中 27 个群集跨越了多个医院。对一个大型的 32 例 ST22-MRSA 群集的分析表明，在任何医院的病房住院期间，32 例患者中有 26 例（81.3%）彼此之间有多次接触。未发现居住、门诊或重要的社区医疗保健接触。来自不同医院的 ST22 型 MRSA 住院患者分离株之间的遗传分化小于来自同一医院的住院患者分离株之间的遗传分化（P≤0.01）。
有证据表明，由于频繁的患者入院到多个医院，MRSA 经常在病房内传播。限制病房内传播需要医院之间共享 MRSA 状况数据。
