Bächli Magi, Sommerstein Rami, Casanova Carlo, Droz Sara, Küffer Marianne, Marschall Jonas
Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland.
Institute for Infectious Diseases, University of Bern, Switzerland.
Infect Prev Pract. 2022 Feb 25;4(2):100211. doi: 10.1016/j.infpip.2022.100211. eCollection 2022 Jun.
The optimal screening strategy in hospitals to identify secondary cases after contact with a meticillin-resistant (MRSA) index patient in a low prevalence setting is not well defined. We aimed at identifying factors associated with documented MRSA transmissions.
Single center, retrospective, nested case-control study. We evaluated the screening strategy in our 950 bed tertiary care hospital from 2008 - 2014. Room and ward contacts of MRSA index patients present at time of MRSA identification were screened. We compared characteristics of Protein A (spa)-type matched contact patients (cases) to negative or spa-type mismatched contact patients (controls).
Among 270,000 inpatients from 2008 - 2014, 215 MRSA screenings yielded 3013 contact patients, and 6 (0.2%) spa-type matched pairs. We included 225 controls for the nested case-control study. The contact type for the cases was more frequently "same room" and less frequently "same ward" compared with the controls ( = 0.001). Also, exposure time was longer for cases (median of 6 days [IQR 3-9]) than for controls (1 day [0-3], =0.016).
The extensive MRSA screening strategy revealed only few index/contact matches based on spa-typing. Prolonged exposure time and a shared room were significantly associated with MRSA transmission. A targeted screening strategy may be more useful in a low prevalence setting than screening entire wards.
在低流行率环境下，医院中用于识别与耐甲氧西林金黄色葡萄球菌（MRSA）索引患者接触后的二代病例的最佳筛查策略尚未明确界定。我们旨在确定与已记录的MRSA传播相关的因素。
单中心、回顾性、巢式病例对照研究。我们评估了2008年至2014年期间在我们拥有950张床位的三级护理医院中的筛查策略。对在MRSA识别时在场的MRSA索引患者的病房和病区接触者进行了筛查。我们将蛋白A（spa）型匹配的接触患者（病例）与阴性或spa型不匹配的接触患者（对照）的特征进行了比较。
在2008年至2014年的270,000名住院患者中，215次MRSA筛查产生了3013名接触患者，以及6对（0.2%）spa型匹配的配对。我们纳入了225名对照进行巢式病例对照研究。与对照相比，病例的接触类型更常为“同一病房”，而较少为“同一病区”（P = 0.001）。此外，病例的暴露时间（中位数为6天[四分位间距3 - 9]）比对照（1天[0 - 3]，P = 0.016）更长。
广泛的MRSA筛查策略仅发现了基于spa分型的少数索引/接触匹配。暴露时间延长和共享病房与MRSA传播显著相关。在低流行率环境下，针对性的筛查策略可能比筛查整个病区更有用。
