通过对患者、医护人员和环境进行广泛采样发现，在一家急症医院中，口腔是金黄色葡萄球菌的一个重要储存库。

The oral cavity revealed as a significant reservoir of Staphylococcus aureus in an acute hospital by extensive patient, healthcare worker and environmental sampling.

作者信息

Kearney A, Kinnevey P, Shore A, Earls M, Poovelikunnel T Thomas, Brennan G, Humphreys H, Coleman D C

机构信息

Microbiology Research Unit, Division of Oral Biosciences, Dublin Dental University Hospital, University of Dublin, Trinity College, Lincoln Place, Dublin 2, Ireland.

出版信息

J Hosp Infect. 2020 Mar 6. doi: 10.1016/j.jhin.2020.03.004.

DOI:10.1016/j.jhin.2020.03.004

PMID:32151672

Abstract

BACKGROUND

Methicillin-susceptible Staphylococcus aureus (MSSA) bloodstream infection rates have risen steadily in recent years, with a marked decline in the corresponding rates due to methicillin-resistant S. aureus (MRSA). Screening for MSSA carriage is not routinely undertaken and MRSA screening is not universal, so the extent of S. aureus colonisation pressure in nosocomial settings is unknown.

METHODS

We conducted a prospective, observational study of patients and healthcare workers (HCWs) across nine inpatient wards in a tertiary referral hospital over a two-year period. Participants were screened for MSSA and MRSA using nasal swabs and oral rinses. Environmental surfaces and air were also tested for S. aureus using contact plates and active air sampling.

FINDINGS

We enrolled 388 patients and 326 HCWs; and took 758 contact plate samples from surfaces and 428 air samples. MSSA was recovered from 24% of patients, 31.3% of HCWs, 16% of air samples and 7.9% of surface samples. MRSA was recovered from 6.4% of patients, 3.7% of HCWs, 2.5% of air samples and 2.2% of surface samples. Inclusion of the oral cavity in addition to the anterior nares in the sampling regimen identified 30 patients and 36 HCWs who exhibited exclusive oral colonisation.

CONCLUSIONS

The oral cavity comprises a significant nosocomial reservoir for S. aureus that is currently under-appreciated. Oral screening should be considered both in terms of the colonisation pressure in a healthcare facility, and on an individual patient level, especially in patients where decolonisation attempts have repeatedly failed and those undergoing high risk procedures.

摘要

背景

近年来，甲氧西林敏感金黄色葡萄球菌（MSSA）血流感染率稳步上升，而耐甲氧西林金黄色葡萄球菌（MRSA）所致的相应感染率则显著下降。目前尚未常规开展MSSA携带情况筛查，且MRSA筛查也未普及，因此医院环境中金黄色葡萄球菌的定植压力程度尚不清楚。

方法

我们在一家三级转诊医院的九个住院病房对患者和医护人员进行了一项为期两年的前瞻性观察研究。采用鼻拭子和口腔含漱液对参与者进行MSSA和MRSA筛查。还使用接触平板和主动空气采样对环境表面和空气进行金黄色葡萄球菌检测。

结果

我们纳入了388例患者和326名医护人员；采集了758份环境表面接触平板样本和428份空气样本。在24%的患者、31.3%的医护人员、16%的空气样本和7.9%的环境表面样本中检测到MSSA。在6.4%的患者、3.7%的医护人员、2.5%的空气样本和2.2%的环境表面样本中检测到MRSA。在采样方案中除前鼻孔外纳入口腔检测，发现30例患者和36名医护人员仅口腔定植。