Heckel Maria, Geißdörfer Walter, Herbst Franziska A, Stiel Stephanie, Ostgathe Christoph, Bogdan Christian
Department of Palliative Medicine, Comprehensive Cancer Center CCC Erlangen-EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Germany.
Mikrobiologisches Institut - Klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen and Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Germany.
PLoS One. 2017 Dec 11;12(12):e0188940. doi: 10.1371/journal.pone.0188940. eCollection 2017.
The emergence of multidrug-resistant bacterial microorganisms is a particular challenge for the health care systems. Little is known about the occurrence of methicillin-resistant Staphylococcus aureus (MRSA) and multidrug-resistant Gram-negative bacteria (MDRGNB) in patients of palliative care units (PCU).
The primary aim of this study was to determine the carriage of MRSA among patients of a PCU at a German University Hospital and to assess whether the positive cases would have been detected by a risk-factor-based screening-approach.
Between February 2014 and January 2015 patients from our PCU were tested for MRSA carriage within 48 hours following admission irrespective of pre-existing risk factors. In addition, risk factors for MRSA colonization were assessed. Samples from the nostrils and, if applicable, from pre-existing wounds were analysed by standardized culture-based laboratory techniques for the presence of MRSA and of other bacteria and fungi. Results from swabs taken prior to admission were also recorded if available.
297 out of 317 patients (93.7%) fulfilled one or more MRSA screening criteria. Swabs from 299 patients were tested. The detection rate was 2.1% for MRSA. All MRSA cases would have been detected by a risk-factor-based screening-approach. Considering the detected cases and the results from swabs taken prior to admission, 4.1% of the patients (n = 13) were diagnosed with MRSA and 4.1% with MDRGNB (n = 13), including two patients with MRSA and MDRGNB (0.6%). The rate of MRSA carriage in PCU patients (4.1%) was elevated compared to the rate seen in the general cohort of patients admitted to our University Hospital (2.7%).
PCU patients have an increased risk to carry MRSA compared to other hospitalized patients. Although a risk factor-based screening is likely to detect all MRSA carriers amongst PCU patients, we rather recommend a universal screening to avoid the extra effort to identify the few risk factor-negative patients (<7%). As we did not perform a systematic MDRGNB screening, further studies are needed to determine the true prevalence of MDRGNB amongst PCU patients.
多重耐药细菌微生物的出现对医疗保健系统构成了特殊挑战。关于姑息治疗病房（PCU）患者中耐甲氧西林金黄色葡萄球菌（MRSA）和多重耐药革兰氏阴性菌（MDRGNB）的发生情况知之甚少。
本研究的主要目的是确定德国一家大学医院PCU患者中MRSA的携带情况，并评估基于风险因素的筛查方法是否能检测出阳性病例。
2014年2月至2015年1月期间，对我们PCU的患者在入院后48小时内进行MRSA携带检测，无论其是否存在既往风险因素。此外，评估MRSA定植的风险因素。通过标准化的基于培养的实验室技术分析来自鼻孔的样本，如有伤口则分析来自现有伤口的样本，以检测MRSA以及其他细菌和真菌的存在。如有入院前采集的拭子结果也进行记录。
317名患者中有297名（93.7%）符合一项或多项MRSA筛查标准。对299名患者的拭子进行了检测。MRSA的检出率为2.1%。所有MRSA病例均可通过基于风险因素的筛查方法检测出来。综合检测病例和入院前拭子结果，4.1%的患者（n = 13）被诊断为MRSA，4.1%的患者（n = 13）被诊断为MDRGNB，其中包括两名同时感染MRSA和MDRGNB的患者（0.6%）。与我院大学医院普通住院患者队列中的MRSA携带率（2.7%）相比，PCU患者中的MRSA携带率（4.1%）有所升高。
与其他住院患者相比，PCU患者携带MRSA的风险增加。虽然基于风险因素的筛查可能会检测出PCU患者中的所有MRSA携带者，但我们更建议进行普遍筛查，以避免为识别少数风险因素阴性患者（<7%）而付出额外努力。由于我们未进行系统的MDRGNB筛查，因此需要进一步研究以确定PCU患者中MDRGNB的真实患病率。
