IDEAS Center, Veterans Affairs Salt Lake City Health Care System.
Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City.
Clin Infect Dis. 2019 Feb 1;68(4):545-553. doi: 10.1093/cid/ciy507.
The Department of Veterans Affairs implemented an active surveillance program for methicillin-resistant Staphylococcus aureus (MRSA) in 2007 in which acute care inpatients are tested for MRSA carriage on admission, unit-to-unit transfer, and discharge. Using these data, we followed patients longitudinally to estimate the difference in infection rates for those who were not colonized, those who were colonized on admission (importers), and those who acquired MRSA during their stay. We examined MRSA infections that occurred prior to discharge and at 30, 90, 180, and 365 days after discharge.
We constructed a dataset of 985626 first admissions from January 2008 through December 2015 who had surveillance tests performed for MRSA carriage. We performed multivariable Cox proportional hazards and logistic regression models to examine the relationship between MRSA colonization status and infection.
The MRSA infection rate across the predischarge and 180-day postdischarge time period was 5.5% in importers and 7.0% in acquirers without a direct admission to the intensive care unit (ICU) and 11.4% in importers and 11.7% in acquirers who were admitted directly to the ICU. The predischarge hazard ratio for MRSA infection was 29.6 (95% confidence interval [CI], 26.5-32.9) for importers and 28.8 (95% CI, 23.5-35.3) for acquirers compared to those not colonized. Fully 63.9% of all MRSA pre- and postdischarge infections among importers and 61.2% among acquirers occurred within 180 days after discharge.
MRSA colonization significantly increases the risk of subsequent MRSA infection. In addition, a substantial proportion of MRSA infections occur after discharge from the hospital.
2007 年，退伍军人事务部实施了耐甲氧西林金黄色葡萄球菌（MRSA）主动监测计划，该计划规定，急性住院患者在入院、单元间转移和出院时都要进行 MRSA 定植检测。利用这些数据，我们对患者进行了纵向随访，以估计未定植患者、入院时定植（进口者）患者和住院期间获得 MRSA 患者的感染率差异。我们检查了出院前和出院后 30、90、180 和 365 天发生的 MRSA 感染。
我们构建了一个数据集，包含 2008 年 1 月至 2015 年 12 月期间 985626 例首次入院患者，这些患者进行了 MRSA 定植检测。我们使用多变量 Cox 比例风险和 logistic 回归模型来检验 MRSA 定植状态与感染之间的关系。
在出院前和 180 天的出院后期间，未直接入住重症监护病房（ICU）的进口者和获得者的 MRSA 感染率分别为 5.5%和 7.0%，而直接入住 ICU 的进口者和获得者的感染率分别为 11.4%和 11.7%。进口者和获得者的 MRSA 感染的出院前危险比分别为 29.6（95%置信区间[CI]，26.5-32.9）和 28.8（95% CI，23.5-35.3），与未定植者相比。进口者和获得者中，所有出院前和出院后 MRSA 感染的 63.9%和 61.2%发生在出院后 180 天内。
MRSA 定植显著增加了随后发生 MRSA 感染的风险。此外，很大一部分 MRSA 感染发生在出院后。
