耐甲氧西林金黄色葡萄球菌鼻腔携带在医院和非医院区域工作的清洁工中的比较：一项横断面研究。
Methicillin-resistant Staphylococcus aureus nasal carriage among janitors working in hospital and non-hospital areas: a comparative cross-sectional study.
机构信息
Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P.O.Box:196, Gondar, Ethiopia.
出版信息
Ann Clin Microbiol Antimicrob. 2020 Oct 19;19(1):47. doi: 10.1186/s12941-020-00391-x.
BACKGROUND
Nasal colonization of Methicillin-resistant Staphylococcus aureus (MRSA) plays a key role in the epidemiology and pathogenesis of both healthcare-associated and community-acquired MRSA infections in various populations. Screening of MRSA nasal colonization is important in the prevention and control of infection and may provide useful information to guide antimicrobial therapy. This study aimed to determine nasal carriage of MRSA, its antimicrobial susceptibility pattern, and associated factors among janitors working in hospital & non-hospital areas at the University of Gondar, Northwest Ethiopia.
METHODS
A comparative cross-sectional study was carried out in a total of 436 study participants (221 hospital and 215 non-hospital janitors) from January to May 2019. The study participants were sampled using a simple random sampling technique. Data on socio-demographic characteristics and associated factors were collected through face to face interviews using a structured questionnaire. Nasal swabs were collected and inoculated into Mannitol salt agar. MRSA was detected using cefoxitin (30 µg) disc and an antibiotic susceptibility test was done using the disc diffusion method. Data were entered and analyzed using SPSS version 20 statistical package. P value ≤ 0.05 was considered as statistically significant.
RESULTS
The overall prevalence of S. aureus was 101/436 [23.2%, (95% CI: 19.3-27.8)], of which, 29.4% (65/221) were isolated from hospital and 16.7% (36/215) non-hospital janitors. The prevalence of MRSA was 4.8% (21/436) [95% CI: 3.0-6.9]; of these, 8.1% (18/221) of the isolates were from the hospital and 1.4% (3/215) non-hospital janitors, while methicillin-sensitive S. aureus (MSSA) in hospital & non-hospital janitors were 49 (22.2%) and 31 (14.4%), respectively. Among the MRSA isolates, 52.4% (11/21) were multi-drug resistant. Of these, 42.9% (9/18) were isolated from hospital and 66.7% (2/3) non-hospital janitors. Hence, nasal carriage of MRSA was significantly associated with hospitalization within the preceding year (AOR = 3.15, CI = 1.13-8.71).
CONCLUSION
The present study revealed that high MSSA and MRSA were isolated from the hospital as compared to non-hospital janitors and high rates of antibiotics resistance were recorded in the hospital janitors. Consequently, hospitalizations were significantly associated with MRSA. Accordingly, regular screening of carriers in apparently healthy janitors is required for the prevention of nosocomial infections.
背景
耐甲氧西林金黄色葡萄球菌（MRSA）的鼻腔定植在不同人群的医院相关和社区获得性 MRSA 感染的流行病学和发病机制中起着关键作用。筛查 MRSA 鼻腔定植对于感染的预防和控制非常重要，并且可以为指导抗菌治疗提供有用的信息。本研究旨在确定在埃塞俄比亚西北部贡德尔大学医院和非医院区域工作的清洁工中，MRSA 的鼻腔携带率、其抗生素药敏模式以及相关因素。
方法
这是一项在 2019 年 1 月至 5 月期间进行的共有 436 名研究参与者（221 名医院清洁工和 215 名非医院清洁工）的比较性横断面研究。使用简单随机抽样技术对研究参与者进行抽样。通过面对面访谈使用结构化问卷收集社会人口统计学特征和相关因素的数据。采集鼻腔拭子并接种到甘露醇盐琼脂中。使用头孢西丁（30μg）圆盘检测 MRSA，使用纸片扩散法进行抗生素药敏试验。使用 SPSS 版本 20 统计软件包输入和分析数据。P 值≤0.05 被认为具有统计学意义。
结果
金黄色葡萄球菌的总流行率为 101/436[23.2%（95%CI：19.3-27.8%）]，其中 29.4%（65/221）分离自医院，16.7%（36/215）分离自非医院清洁工。MRSA 的流行率为 4.8%（21/436）[95%CI：3.0-6.9%]；其中，8.1%（18/221）的分离株来自医院，1.4%（3/215）来自非医院清洁工，而医院和非医院清洁工的甲氧西林敏感金黄色葡萄球菌（MSSA）分别为 49（22.2%）和 31（14.4%）。在 MRSA 分离株中，52.4%（11/21）为多药耐药。其中，42.9%（9/18）分离自医院，66.7%（2/3）分离自非医院清洁工。因此，MRSA 的鼻腔携带与前一年的住院治疗显著相关（AOR=3.15，CI=1.13-8.71）。
结论
本研究表明，与非医院清洁工相比，医院中分离出的 MSSA 和 MRSA 数量较高，并且医院清洁工中记录到较高的抗生素耐药率。因此，住院治疗与 MRSA 显著相关。因此，需要对看似健康的清洁工进行定期筛查，以预防医院感染。
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