Crowcroft N, Maguire H, Fleming M, Peacock J, Thomas J
Department of Public Health Sciences, St George's Hospital Medical School, London, UK.
J Hosp Infect. 1996 Dec;34(4):301-9. doi: 10.1016/s0195-6701(96)90110-3.
A retrospective case-control study of 50 MRSA-positive patients was carried out during an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) at an acute general hospital in London. Controls were randomly selected from MRSA-negative patients admitted during the outbreak period. Risk factors investigated included length of admission prior to screening, number of ward changes, main diagnosis, extent of staff contact, pressure sores, surgical and other invasive procedures and antibiotic treatment. Outcome variables examined were rates of infection (versus colonization) with MRSA and mortality. Patients with MRSA were in hospital longer before microbiological specimens were taken and moved wards more often than controls. In a logistic regression analysis, length of stay in hospital, pressure sores, physiotherapy and surgical procedures were associated with a significantly increased risk of acquiring MRSA. Odds ratios (and 95% confidence intervals) for having acquired MRSA were: 8.3 (1.02-71.43) if a patient had pressure sores; 3.7 (1.10-12.5) if they received physiotherapy; and 3.2 (1.82-10.0) if they underwent surgical procedures. The rate of clinical infection amongst patients with this strain of MRSA was 26% and included life-threatening infections such as septicaemia, underlining the potential virulence of MRSA. Surgery and physiotherapy may have been markers of debility. Physiotherapy was probably a marker of increased rates of contact with all hospital staff, and high standards of hand hygiene should be promoted amongst all staff as the most important factor in controlling an outbreak of MRSA. Good bed management is essential for hospital infection control.
在伦敦一家急症综合医院耐甲氧西林金黄色葡萄球菌（MRSA）暴发期间，对50例MRSA阳性患者进行了一项回顾性病例对照研究。对照从暴发期间入院的MRSA阴性患者中随机选取。调查的危险因素包括筛查前的住院时间、病房更换次数、主要诊断、医护人员接触程度、压疮、手术及其他侵入性操作和抗生素治疗。所检查的结果变量为MRSA感染（与定植相比）率和死亡率。与对照组相比，MRSA患者在采集微生物标本前住院时间更长，更换病房更频繁。在逻辑回归分析中，住院时间、压疮、物理治疗和手术操作与感染MRSA的风险显著增加相关。感染MRSA的比值比（及95%置信区间）为：有压疮的患者为8.3（1.02 - 71.43）；接受物理治疗的患者为3.7（1.10 - 12.5）；接受手术操作的患者为3.2（1.82 - 10.0）。该株MRSA患者的临床感染率为26%，包括败血症等危及生命的感染，突显了MRSA的潜在毒力。手术和物理治疗可能是虚弱的标志。物理治疗可能是与所有医院工作人员接触率增加的一个标志，应促使所有工作人员保持高标准的手部卫生，这是控制MRSA暴发的最重要因素。良好的床位管理对医院感染控制至关重要。
