Terpenning M S, Bradley S F, Wan J Y, Chenoweth C E, Jorgensen K A, Kauffman C A
Division of Geriatric Medicine, University of Michigan Medical School, Ann Arbor.
J Am Geriatr Soc. 1994 Oct;42(10):1062-9. doi: 10.1111/j.1532-5415.1994.tb06210.x.
To assess colonization and infection with methicillin-resistant Staphylococcus aureus (MRSA), high-level gentamicin-resistant enterococci (R-ENT) and gentamicin and/or ceftriaxone-resistant Gram-negative bacilli (R-GNB) and the factors that are associated with colonization and infection with these organisms.
Monthly surveillance for colonization and infection over a period of 2 years. In the second year, an intervention to decrease MRSA colonization by the use of mupirocin ointment was carried out.
Long-term care facility attached to an acute care Veterans Affairs Medical Center.
A total of 551 patients in the facility were followed for a period of 2 years.
Colonization and infection rates with MRSA, R-ENT, and R-GNB. Analysis of risk factors associated with colonization and infection with these three groups of organisms.
In the first year, colonization rates were highest for MRSA (22.7 +/- 1% patients colonized each month) and R-ENT (20.2 +/- 1%) and lower for R-GNB (12.6 +/- 1%). After introduction of decolonization of nares and wounds with mupirocin, the rate of MRSA colonization fell significantly to 11.5 +/- 1.8%, but rates remained unchanged for R-ENT and R-GNB. Risk factors for MRSA colonization included the presence of wounds and decubitus ulcers. For R-ENT, the presence of wounds, renal failure, intermittent urethral catheterization, low serum albumin, and poor functional level were significant. For R-GNB, intermittent urethral catheterization, chronic renal disease, inflammatory bowel disease, presence of wounds, and prior pneumonia were significantly associated with colonization. Overall, of infections caused by known organisms, 49.6% were due to MRSA, R-ENT, or R-GNB, and 50.4% were due to susceptible organisms. Infections were more commonly due to R-GNB (21.1% of all infections) than to R-ENT (8.3%) or MRSA (4.6%). The most common infections were urinary tract infections (42.9% of all infections) and skin and soft tissue infections (31.9% of all infections). Risk factors for MRSA infections were diabetes mellitus and peripheral vascular disease, for R-GNB infections were intermittent urethral catheterization and indwelling urethral catheters, and no one factor was associated with R-ENT infection.
In our long-term care facility, colonization with resistant MRSA and R-ENT was more common than R-GNB, but infections were more often due to R-GNB than R-ENT and MRSA. Several host factors, which potentially could be modified in order to prevent infections, emerged as important in colonization and infection with these antibiotic-resistant organisms.
评估耐甲氧西林金黄色葡萄球菌（MRSA）、高水平耐庆大霉素肠球菌（R-ENT）以及耐庆大霉素和/或头孢曲松革兰阴性杆菌（R-GNB）的定植与感染情况，以及与这些微生物定植和感染相关的因素。
为期2年的每月定植与感染监测。在第二年，开展了一项使用莫匹罗星软膏减少MRSA定植的干预措施。
一所附属于急症护理退伍军人事务医疗中心的长期护理机构。
该机构共551名患者接受了为期2年的随访。
MRSA、R-ENT和R-GNB的定植率与感染率。分析与这三组微生物定植和感染相关的危险因素。
第一年，MRSA的定植率最高（每月定植患者为22.7±1%），R-ENT次之（20.2±1%），R-GNB较低（12.6±1%）。在采用莫匹罗星进行鼻腔和伤口去定植后，MRSA定植率显著降至11.5±1.8%，但R-ENT和R-GNB的定植率保持不变。MRSA定植的危险因素包括伤口和压疮的存在。对于R-ENT，伤口、肾衰竭、间歇性尿道插管、低血清白蛋白和功能水平差具有显著意义。对于R-GNB，间歇性尿道插管、慢性肾病、炎症性肠病、伤口的存在以及既往肺炎与定植显著相关。总体而言，在已知微生物引起的感染中，49.6%由MRSA、R-ENT或R-GNB引起，50.4%由敏感微生物引起。感染更常见于R-GNB（占所有感染的21.1%），而非R-ENT（8.3%）或MRSA（4.6%）。最常见的感染是尿路感染（占所有感染的42.9%）和皮肤及软组织感染（占所有感染的31.9%）。MRSA感染的危险因素是糖尿病和外周血管疾病，R-GNB感染的危险因素是间歇性尿道插管和留置尿道导管，且没有单一因素与R-ENT感染相关。
在我们的长期护理机构中，耐抗生素MRSA和R-ENT的定植比R-GNB更常见，但感染更多由R-GNB而非R-ENT和MRSA引起。出现了几个可能为预防感染而改变的宿主因素，它们在这些耐抗生素微生物的定植和感染中具有重要意义。
