Olona-Cabases M, Ticó-Falguera N, Ramírez-Garcerán L, Del Valle-Ortiz O, Castelló-Verdú T, García-Fernández L
Spinal Cord Injury Unit, Traumatology and Rehabilitation University Hospital, Barcelona, Spain.
Spinal Cord. 1996 Jun;34(6):315-9. doi: 10.1038/sc.1996.58.
Methicillin-Resistant Staphylococcus aureus (MRSA) infection poses a problem for both acute and long-term-care facilities, Spinal Cord Injury units included. This paper describes the 4-year evolution of MRSA outbreaks in a SCI unit in a university hospital where control measures were implemented from the first case detected. The protocol procedure was as follows: contact isolation, washing with antiseptic soap both those infected and those sharing the same room, contacts study and monitoring of MRSA patients up to the time when three consecutive negative cultures (sampled at time lapses of over 48 h) were obtained, antiseptic soap for the health-care personnel to wash their hands, and cultures of the nares done on the personnel in the event of an outbreak. Twenty-one (3.4%) MRSA positive cases were detected out of 550 admissions registered during the study period (November 1990 through October 1994). The evolution occurred in three outbreaks and six isolated MRSA positive patients without secondary cases. 71.5% of the cases were nosocomial. Seven (33%) were colonizated and 14 (67%) infected. The 14 patients infected presented 15 infections: nine with urinary tract infections, three surgical wound infections, two tracheostomy wound infections, and one patient with a decubitus ulcer infection. Two of those with urinary tract infections presented with secondary sepsis. No carriers were detected amongst the personnel. Urinary tract colonizations responded to treatment with cotrimoxazol except in two cases in which combined treatment was required (cotrimoxazol plus rifampicin). The patients with a MRSA positive tracheal aspirate were negative after combined treatment. Wounds and cultures of the nares responded favorably to initial treatment. One of the patients with a urinary tract infection and sepsis died the infection being a contributing cause. The prospective follow-up of the patients with MRSA positive cultures and the precocious implementation of isolation measures allow for the limitation of transmission, even although complete eradication is not possible.
耐甲氧西林金黄色葡萄球菌（MRSA）感染给急性和长期护理机构都带来了问题，脊髓损伤病房也不例外。本文描述了一所大学医院脊髓损伤病房MRSA暴发的4年演变情况，自检测到首例病例后便实施了控制措施。方案流程如下：接触隔离，对感染者和同室人员均用抗菌皂清洗，进行接触者调查并对MRSA患者进行监测，直至连续三次培养结果为阴性（采样间隔超过48小时），医护人员用抗菌皂洗手，暴发时对工作人员进行鼻腔培养。在研究期间（1990年11月至1994年10月）登记的550例入院患者中，检测出21例（3.4%）MRSA阳性病例。演变过程发生了三次暴发，还有6例孤立的MRSA阳性患者且无继发病例。71.5%的病例为医院感染。7例（33%）为定植，14例（67%）为感染。14例感染患者出现了15次感染：9例为尿路感染，3例为手术伤口感染，2例为气管造口伤口感染，1例为压疮溃疡感染。其中2例尿路感染患者出现了继发性败血症。工作人员中未检测到携带者。除2例需要联合治疗（复方新诺明加利福平）外，尿路感染定植经复方新诺明治疗有效。气管吸出物MRSA阳性的患者经联合治疗后转阴。伤口和鼻腔培养对初始治疗反应良好。1例尿路感染合并败血症的患者死亡，感染是一个促成因素。对MRSA培养阳性患者的前瞻性随访以及隔离措施的及早实施，即使无法完全根除，也能限制传播。
