Wang Bing, Suh Kathryn N, Muldoon Katherine A, Oake Natalie, Forster Alan, Ramotar Karam, Roth Virginia R
Department of Pathology and Laboratory Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, ON.
Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, ON; Ottawa Hospital Research Institute, Ottawa, ON; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON.
J Obstet Gynaecol Can. 2018 Jun;40(6):669-676. doi: 10.1016/j.jogc.2017.09.025. Epub 2017 Dec 13.
Methicillin-resistant Staphylococcus aureus (MRSA) among obstetrical patients can increase birth complications for both mothers and infants, but little is known about the risk factors for MRSA in this population. The objective of this study was to determine the prevalence of MRSA among obstetrical patients and identify risk factors associated with MRSA colonization.
This nested case-control study used obstetrical patients with MRSA colonization identified through a universal screening program at The Ottawa Hospital (February 2008-January 2010). Cases and three matched controls were compared using chi-square tests for categorical variables, median and interquartile range (IQR), and Wilcoxon rank-sum tests for continuous variables. Conditional logistic regression using ORs and 95% CIs was used to identify risk factors. Standard microbiologic techniques and pulsed-field gel electrophoresis of the MRSA isolates from case patients were performed.
Out of 11 478 obstetrical patients, 39 (0.34%) were MRSA colonized; 117 patients were selected as matched controls. The median age was 30 (IQR 27.5-35.00) and median length of stay was 2.55 days (IQR 1.95-3.24). Only MRSA cases had a previous MRSA infection (4 vs. 0). MRSA cases had significantly higher parity (median 3; IQR 2-5) compared with controls (median 2; IQR 1-3) (OR 1.52; 95% CI 1.22-1.90) CONCLUSION: This study identified a low prevalence of MRSA among obstetrical patients. Risk factors associated with MRSA colonization were previous MRSA infection and multiparity. Obstetrical patients who previously tested positive for MRSA should be placed on contact precautions at the time of hospital admission because this is a risk factor for future colonization.
产科患者中的耐甲氧西林金黄色葡萄球菌（MRSA）会增加母婴的分娩并发症，但对于该人群中MRSA的危险因素知之甚少。本研究的目的是确定产科患者中MRSA的患病率，并识别与MRSA定植相关的危险因素。
这项巢式病例对照研究使用了通过渥太华医院的一项通用筛查计划（2008年2月至2010年1月）确定的MRSA定植的产科患者。对于分类变量，使用卡方检验比较病例组和三个匹配对照组；对于连续变量，使用中位数和四分位数间距（IQR）以及Wilcoxon秩和检验。使用比值比（OR）和95%置信区间（CI）的条件逻辑回归来识别危险因素。对病例患者的MRSA分离株进行了标准微生物学技术和脉冲场凝胶电泳分析。
在11478名产科患者中，39名（0.34%）被MRSA定植；117名患者被选为匹配对照组。中位年龄为30岁（IQR 27.5 - 35.00），中位住院时间为2.55天（IQR 1.95 - 3.24）。只有MRSA病例曾有过MRSA感染（4例 vs. 0例）。与对照组（中位数2；IQR 1 - 3）相比，MRSA病例的产次显著更高（中位数3；IQR 2 - 5）（OR 1.52；95% CI 1.22 - 1.90）。结论：本研究发现产科患者中MRSA的患病率较低。与MRSA定植相关的危险因素是既往MRSA感染和多产。既往MRSA检测呈阳性的产科患者在入院时应采取接触预防措施，因为这是未来定植的一个危险因素。
