Department of Internal Medicine, Division of Geriatric and Palliative Medicine, University of Michigan Medical School, Ann Arbor.
Henry Ford Health System, Detroit.
Clin Infect Dis. 2018 Aug 31;67(6):861-868. doi: 10.1093/cid/ciy115.
Most nursing facilities (NFs) lack methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) surveillance programs due to limited resources and high costs. We investigated the utility of environmental screening of high-touch surfaces in patient rooms as a way to circumvent these challenges.
We compared MRSA and VRE culture data from high-touch surfaces in patients' rooms (14450 samples from 6 NFs) and ranked each site's performance in predicting patient colonization (7413 samples). The best-performing sites were included in a MRSA- and a VRE-specific panel that functioned as a proxy for patient colonization. Molecular typing was performed to confirm available concordant patient-environment pairs.
We identified and validated a MRSA panel that consisted of the bed controls, nurse call button, bed rail, and TV remote control. The VRE panel included the toilet seat, bed controls, bed rail, TV remote control, and top of the side table. Panel colonization data tracked patient colonization. Negative predictive values were 89%-92% for MRSA and 82%-84% for VRE. Molecular typing confirmed a strong clonal type relationship in available concordant patient-environment pairs (98% for MRSA, 91% for VRE), pointing to common epidemiological patterns for environmental and patient isolates.
Environmental panels used as a proxy for patient colonization and incorporated into facility surveillance protocols can guide decolonization strategies, improve awareness of MRSA and VRE burden, and inform efforts to reduce transmission. Targeted environmental screening may be a viable surveillance strategy for MRSA and VRE detection in NFs.
由于资源有限和成本高昂，大多数护理机构（NFs）缺乏耐甲氧西林金黄色葡萄球菌（MRSA）和万古霉素耐药肠球菌（VRE）监测计划。我们研究了在患者房间内对高接触表面进行环境筛查作为克服这些挑战的一种方法的实用性。
我们比较了患者房间内高接触表面的 MRSA 和 VRE 培养数据（来自 6 个 NF 的 14450 个样本），并对每个部位预测患者定植的性能进行了排名（7413 个样本）。表现最好的部位被纳入一个针对 MRSA 和 VRE 的专用面板，作为患者定植的替代物。进行分子分型以确认可用的一致患者-环境对。
我们确定并验证了一个由床头控制、呼叫按钮、床栏和电视遥控器组成的 MRSA 面板。VRE 面板包括马桶座圈、床头控制、床栏、电视遥控器和边桌顶部。面板定植数据追踪患者定植情况。MRSA 的阴性预测值为 89%-92%，VRE 的为 82%-84%。分子分型证实了可用一致的患者-环境对中存在很强的克隆型关系（MRSA 为 98%，VRE 为 91%），表明环境和患者分离株存在共同的流行病学模式。
用作患者定植替代物并纳入设施监测方案的环境面板可指导去定植策略，提高对 MRSA 和 VRE 负担的认识，并为减少传播提供信息。针对环境的靶向筛选可能是 NF 中检测 MRSA 和 VRE 的一种可行监测策略。
