Mulhausen P L, Harrell L J, Weinberger M, Kochersberger G G, Feussner J R
Geriatric Research, Education, and Clinical Center, VAMC Durham, North Carolina, USA.
Am J Med. 1996 Jan;100(1):24-31. doi: 10.1016/s0002-9343(96)90007-8.
To compare the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) nares colonization, the patterns of MRSA acquisition, and the risk for subsequent MRSA infection between a hospital-based, Department of Veterans Affairs (VA) nursing home care unit (NHCU) and community-based nursing homes.
In this prospective study, 148 residents of three community nursing homes and 55 residents of a VA NHCU had their anterior nares swabbed; repeat cultures were obtained from hospitalized patients and/or individuals colonized with MRSA. Subjects were followed up prospectively for 1 year to note hospitalizations and the development of MRSA infections.
The prevalence of MRSA colonization was significantly higher in the VA NHCU than in the community nursing homes (mean +/- SD 30.3% +/- 11% versus 9.9% +/- 4%). The rate of MRSA nares colonization was similar in the two settings. Acquisition of MRSA took place in both the long-term care facilities and hospitals, with 23.8% of incident cases occurring during a hospitalization. Only 3 of the 27 individuals colonized at baseline developed an MRSA infection. A trend toward an increased rate of infection was seen in colonized individuals residing in the community nursing homes versus those in the VA NHCU (relative risk 4.67; 95% Cl 0.55 to 39.9). Forty-seven percent of the 55 subjects hospitalized were colonized at some point during the study. In contrast to residents of the VA NHCU, MRSA colonization in the community facilities was a marker for high mortality.
Outcomes from colonization may be different in the VA NHCU population and the community nursing home population.
比较退伍军人事务部（VA）医院附属护理院护理单元（NHCU）与社区护理院之间耐甲氧西林金黄色葡萄球菌（MRSA）鼻腔定植的患病率、MRSA获得模式以及后续发生MRSA感染的风险。
在这项前瞻性研究中，对三家社区护理院的148名居民和一家VA NHCU的55名居民进行前鼻孔拭子采样；对住院患者和/或MRSA定植个体进行重复培养。对受试者进行为期1年的前瞻性随访，记录住院情况和MRSA感染的发生情况。
VA NHCU中MRSA定植的患病率显著高于社区护理院（均值±标准差为30.3%±11%，而社区护理院为9.9%±4%）。两种环境下MRSA鼻腔定植率相似。MRSA在长期护理机构和医院中均有获得，23.8%的新发病例发生在住院期间。基线时定植的27名个体中只有3人发生了MRSA感染。与VA NHCU中的个体相比，社区护理院中的定植个体有感染率增加的趋势（相对风险4.67；95%可信区间0.55至39.9）。55名住院受试者中有47%在研究期间的某个时间点被定植。与VA NHCU的居民不同，社区机构中的MRSA定植是高死亡率的一个标志。
VA NHCU人群和社区护理院人群定植的结果可能不同。
