Department of Medical Microbiology, Leiden University Medical Center, Leiden University, Leiden, The Netherlands.
Department of Microbiology, Medical Laboratories, Reinier de Graaf Groep, Delft, The Netherlands.
Antimicrob Resist Infect Control. 2024 Aug 27;13(1):92. doi: 10.1186/s13756-024-01448-8.
The prevention of methicillin-resistant S. aureus (MRSA) transmission in the healthcare setting is a priority in Infection Control practices. A cornerstone of this policy is contact tracing of nosocomial contacts after an unexpected MRSA finding. The objective of this retrospective study was to quantify the rates of MRSA transmission in different clinical settings.
This multi-centre study included MRSA contact screening results from two regional hospitals and one academic hospital. MRSA contact tracing investigations from 2000 until 2019 were reviewed and post-contact screening results were included of index patients with an MRSA-positive culture and their unprotected contacts. Available typing results were used to rule out incidental findings.
Of 27,377 contacts screened after MRSA exposure, 21,488 were Health Care Workers (HCW) and 4816 patients. Post-contact screening was initiated for a total of 774 index cases, the average number of screened contacts per index case was 35.7 (range 1 to 640). MRSA transmission was observed in 0.15% (41) of the contacts, 19 (0.09%) HCW and 22 (0.46%) patients. The number needed to screen to detect one MRSA transmission was 667. The highest risk of MRSA transmission occurred during patient-to-patient contacts, with transmission rates varying from 0.32 to 1.32% among the participating hospitals. No transmissions were detected in HCW (n=2834) in the outpatient setting, and the rate of transmissions among HCW contacts on the wards was 0.13% (19 of 15,874). Among 344 contacts of patients with contact precautions, no transmissions were detected.
Reconsidering current MRSA contact tracing practices may lead to a more targeted approach with a lower number needed to screen.
在医疗机构中预防耐甲氧西林金黄色葡萄球菌（MRSA）的传播是感染控制实践的重点。该政策的基石之一是在发现意外的 MRSA 后对医院接触者进行接触追踪。本回顾性研究的目的是量化不同临床环境中 MRSA 传播的发生率。
这项多中心研究包括来自两家地区医院和一家学术医院的 MRSA 接触筛查结果。对 2000 年至 2019 年的 MRSA 接触追踪调查进行了回顾，并纳入了索引患者 MRSA 阳性培养物及其未受保护接触者的接触后筛查结果。可利用的分型结果用于排除偶发发现。
在 27377 名接触者中，有 21488 名是医护人员（HCW），4816 名是患者。共对 774 例索引病例启动了接触后筛查，每位索引病例平均筛查的接触者为 35.7 人（范围为 1 至 640 人）。在 41 名接触者中观察到 MRSA 传播，其中 19 名（0.09%）是 HCW，22 名（0.46%）是患者。筛查发现一例 MRSA 传播的人数为 667 人。患者之间的接触者发生 MRSA 传播的风险最高，参与医院的传播率在 0.32%至 1.32%之间。在门诊环境中，未在 2834 名 HCW 中检测到传播，病房 HCW 接触者的传播率为 0.13%（15874 名中的 19 名）。在 344 名有接触预防措施的患者接触者中，未检测到传播。
重新考虑当前的 MRSA 接触追踪实践可能会导致采取更有针对性的方法，减少需要筛查的人数。
