Department of Infection Control, Amphia Hospital, P.O. Box 90158, 4800 AK Breda, the Netherlands; Medical Microbiology, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands.
Laboratory for Microbiology, Admiraal De Ruyter Hospital, P.O. Box 15, 4460 AA Goes, the Netherlands.
Clin Microbiol Infect. 2019 Nov;25(11):1428.e1-1428.e5. doi: 10.1016/j.cmi.2019.03.012. Epub 2019 Mar 27.
We determined the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) nasal carriage upon hospital admission, among patients who were screened preoperatively for nasal S. aureus carriage between 2010 and 2017. We also aimed to evaluate the prevalence of MRSA carriers without the standard risk factors.
We conducted an observational study to determine the prevalence of MRSA nasal carriage among patients who were screened preoperatively for nasal S. aureus carriage between 2010 and 2017. Samples of cardiothoracic patients were tested by polymerase chain reaction (PCR), other samples were cultured using chromogenic agar plates. A Poisson regression model with robust error variance was used to assess whether there was a trend in the prevalence of MRSA over time.
In total, 31 093 nasal swabs were obtained from 25 660 patients. Three-hundred and seventy-five swabs (1.2%) had an invalid result. Therefore, 30 718 swabs (98.8%) were included in our analysis. Overall, S. aureus was detected in 7981/30 718 patients (26.0% 95% CI 25.5-26.5%) of whom 41 were MRSA (0.13% 95% CI 0.10-0.18%). The MRSA prevalence varied from 0.03% to 0.17% over the years without evidence of a changing trend over time (p = 0.40). Results of the questionnaire revealed that 30 of the 41 patients (73.2%) had no known risk factors for MRSA carriage (0.10%; 95% CI 0.07-0.14%).
Our study revealed a sustained low prevalence of MRSA carriage upon hospital admission over 7 years. This supports the effectiveness of the Dutch Search and Destroy policy, in combination with a restrictive antibiotic prescription policy.
我们确定了 2010 年至 2017 年间，在术前筛查鼻内金黄色葡萄球菌（S. aureus）携带情况的住院患者中，耐甲氧西林金黄色葡萄球菌（MRSA）鼻内携带的患病率。我们还旨在评估无标准危险因素的 MRSA 携带者的患病率。
我们进行了一项观察性研究，以确定 2010 年至 2017 年间，在术前筛查鼻内 S. aureus 携带情况的住院患者中，MRSA 鼻内携带的患病率。通过聚合酶链反应（PCR）对心胸患者的样本进行检测，使用显色琼脂平板对其他样本进行培养。采用具有稳健误差方差的泊松回归模型来评估 MRSA 的患病率是否随时间呈趋势变化。
总共从 25660 名患者中获得了 31093 个鼻拭子。375 个拭子（1.2%）的结果无效。因此，30718 个拭子（98.8%）被纳入我们的分析。总体而言，30718 名患者中有 7981 名（26.0% 95%CI 25.5-26.5%）检测到 S. aureus，其中 41 名为 MRSA（0.13% 95%CI 0.10-0.18%）。MRSA 的患病率在过去 7 年中从 0.03%到 0.17%不等，没有证据表明随着时间的推移呈趋势变化（p=0.40）。问卷调查结果显示，41 名患者中有 30 名（73.2%）无 MRSA 携带的已知危险因素（0.10% 95%CI 0.07-0.14%）。
我们的研究揭示了 7 年来，住院患者中 MRSA 携带率持续保持低水平。这支持了荷兰搜索和消灭政策与限制抗生素处方政策相结合的有效性。
