Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
Division of Infectious Diseases, National University Hospital, Singapore, Singapore.
PLoS One. 2021 Jul 22;16(7):e0254852. doi: 10.1371/journal.pone.0254852. eCollection 2021.
Methicillin-Resistant Staphylococcus aureus (MRSA) is endemic in hospitals worldwide. Intrahospital transfers may impact MRSA acquisition risk experienced by patients. In this study, we investigated ward characteristics and connectivity that are associated with MRSA acquisition.
We analysed electronic medical records on patient transfers and MRSA screening of in-patients at an acute-care tertiary hospital in Singapore to investigate whether ward characteristics and connectivity within a network of in-patient wards were associated with MRSA acquisition rates over a period of four years.
Most patient transfers concentrated in a stable core network of wards. Factors associated with increased rate of MRSA acquisition were MRSA prevalence among patients transferred from other wards (rate ratio (RR): 7.74 [95% confidence interval (CI): 3.88, 15.44], additional 5 percentage point), critical care ward (RR: 1.72 [95% CI: 1.09, 2.70]) and presence of MRSA cohorting beds (RR: 1.39 [95% CI: 1.03, 1.90]. Oncology ward (RR: 0.66 [95% CI: 0.46, 0.94]) (compared to medical ward), and median length of stay (RR: 0.70 [95% CI: 0.55, 0.90], additional 1.5 days) were associated with lower acquisition rates. In addition, we found evidence of interaction between MRSA prevalence among patients transferred from other wards and weighted in-degree although the latter was not associated with MRSA acquisition after controlling for confounders.
Wards with higher MRSA prevalence among patients transferred from other wards were more likely to have higher MRSA acquisition rate. Its effect further increased in wards receiving greater number of patients. In addition, critical care ward, presence of MRSA cohorting beds, ward specialty, and median length of stay were associated with MRSA acquisition.
耐甲氧西林金黄色葡萄球菌（MRSA）在全球医院中普遍存在。院内转科可能会影响患者的 MRSA 感染风险。在这项研究中，我们调查了与 MRSA 获得相关的病房特征和连通性。
我们分析了新加坡一家急性护理三级医院的住院患者转科和 MRSA 筛查的电子病历，以调查在四年期间，病房特征和住院病房网络内的连通性是否与 MRSA 获得率相关。
大多数患者转科集中在一个稳定的核心病房网络中。与 MRSA 获得率增加相关的因素包括从其他病房转来的患者中 MRSA 的流行率（率比（RR）：7.74[95%置信区间（CI）：3.88，15.44]，增加 5 个百分点）、重症监护病房（RR：1.72[95% CI：1.09，2.70]）和存在 MRSA 集中护理床位（RR：1.39[95% CI：1.03，1.90]）。与内科病房相比，肿瘤病房（RR：0.66[95% CI：0.46，0.94]）和中位住院时间（RR：0.70[95% CI：0.55，0.90]，增加 1.5 天）与较低的获得率相关。此外，我们发现从其他病房转来的患者中 MRSA 流行率与加权入度之间存在交互作用，尽管在控制了混杂因素后，后者与 MRSA 获得无关。
从其他病房转来的患者中 MRSA 流行率较高的病房更有可能获得更高的 MRSA 获得率。其效果在接收更多患者的病房中进一步增加。此外，重症监护病房、MRSA 集中护理床位的存在、病房专业和中位住院时间与 MRSA 获得相关。
