Kanagasingham Kalai C, Ho Kwok M, Robinson J Owen
Department of Intensive Care Medicine, Royal Perth Hospital, Perth, Australia.
School of Veterinary and Life Sciences, Murdoch University, Perth, Australia.
Anaesth Intensive Care. 2020 May;48(3):196-202. doi: 10.1177/0310057X20911925. Epub 2020 Apr 27.
Staphylococcal infection is associated with significant morbidity and mortality in critically ill patients. Using data from 16,681 patients who had a nasal polymerase chain reaction (PCR) assay on admission to the intensive care unit (ICU) of Royal Perth Hospital between March 2006 and September 2016, this retrospective cohort study assessed whether nasal colonisation on admission to an ICU was predictive of concurrent or subsequent infections. Culture-proven infections were identified using the hospital microbiology database. Of the 16,681 patients included, 565 (3.4%) had a positive methicillin-resistant (MRSA) assay, 146 (0.9%) had a positive methicillin-sensitive (MSSA) assay and eight (0.05%) had both positive MRSA and MSSA assays. Of those 565 patients with a positive MRSA PCR assay, 79 (13.8%) had concurrent or subsequent MRSA infections. Of those 146 patients with a positive MSSA PCR assay, only 5 (3.4%) had MSSA infection. The sensitivity and specificity for the MRSA PCR assay in predicting concurrent or subsequent MRSA infection were 72.7% (95% confidence intervals (CI) 63.4%-80.8%) and 97.0% (95% CI 96.8%-97.3%), respectively. The sensitivity and specificity for the MSSA PCR assay in predicting concurrent or subsequent MSSA infection were 3.3% (95% CI 1.1%-7.6%) and 99.1% (95% CI 98.9%-99.2%), respectively. Both nasal MRSA and MSSA PCR assays had a high specificity and negative predictive value in predicting MRSA and MSSA infections, respectively, suggesting that in centres without endemic infections, a negative nasal MRSA or MSSA PCR assay may be useful to reduce unnecessary empirical antibiotic therapy against
葡萄球菌感染在重症患者中与显著的发病率和死亡率相关。本回顾性队列研究利用2006年3月至2016年9月期间在皇家珀斯医院重症监护病房（ICU）入院时接受鼻腔聚合酶链反应（PCR）检测的16681例患者的数据，评估ICU入院时的鼻腔定植是否可预测同时发生或随后发生的感染。通过医院微生物数据库确定经培养证实的感染。在纳入的16681例患者中，565例（3.4%）耐甲氧西林金黄色葡萄球菌（MRSA）检测呈阳性，146例（0.9%）甲氧西林敏感金黄色葡萄球菌（MSSA）检测呈阳性，8例（0.05%）MRSA和MSSA检测均呈阳性。在565例MRSA PCR检测呈阳性的患者中，79例（13.8%）发生了同时或随后的MRSA感染。在146例MSSA PCR检测呈阳性的患者中，只有5例（3.4%）发生了MSSA感染。MRSA PCR检测预测同时或随后MRSA感染的敏感性和特异性分别为72.7%（95%置信区间（CI）63.4%-80.8%）和97.0%（95%CI 96.8%-97.3%）。MSSA PCR检测预测同时或随后MSSA感染的敏感性和特异性分别为3.3%（95%CI 1.1%-7.6%）和99.1%（95%CI 98.9%-99.2%）。鼻腔MRSA和MSSA PCR检测在预测MRSA和MSSA感染方面分别具有较高的特异性和阴性预测价值，这表明在没有地方性感染的中心，鼻腔MRSA或MSSA PCR检测阴性可能有助于减少针对……的不必要经验性抗生素治疗
