Cosseron-Zerbib M, Roque Afonso A M, Naas T, Durand P, Meyer L, Costa Y, el Helali N, Huault G, Nordmann P
Service de Bactériologie-Virologie-Hygiène, Hôpital de Bicêtre, Université Paris Sud, Clamart Cedex, France.
J Hosp Infect. 1998 Nov;40(3):225-35. doi: 10.1016/s0195-6701(98)90140-2.
Methicillin-resistant Staphylococcus aureus (MRSA) is increasingly reported as a hospital-acquired pathogen in intensive care units (ICUs). The inconsistent application of hygiene measures by healthcare workers accounts largely for the epidemic dissemination of such resistant strains. The efficacy of a control programme to prevent spread of MRSA was assessed in our paediatric ICU (PICU) from April 1992 to December 1995. Patients initially had weekly MRSA cultures taken from samples of anterior nares and perineum, but from January 1994, cultures were also obtained upon admission. Immediately after notification, all MRSA carriers were isolated. Education of hospital staff was an essential component of our programme. Nosocomial infection rates were recorded retrospectively in 1992 and 1993, and prospectively in 1994 and 1995. Incidence rates between 'pre-programme' and 'programme' periods were compared. The rate of MRSA infection decreased from 5.9-0.8/1000 Patient-Days (PD), (P < 10(-7). MRSA carriage also decreased from 34-2% (P < 10(-9) and the ratio of MRSA to all S. aureus fell from 71-11% (P < 10(-4). The decrease in the global incidence of infection from 20.1-13.9/1000 PD (P = 0.002) was due only to the decrease in MRSA infection. However, between 1994 and 1995, there was a significant increase in the number of transplant patients despite a constant patient/nurse ratio. The nosocomial infection rates caused by other micro-organisms decreased among the transplant patients from 64.8-33.2/1000 transplanted PD (P = 0.009) between 1994 and 1995. At the same time, we observed a slight increase of infections in non-transplanted patients, which may have been due to the effect of increased overall workload on those patients who were supposed to have fewer nosocomial risk factors. We conclude that implementation of infection control measures directed towards limiting person-to-person spread was effective in controlling high MRSA infection rates in a PICU, but it is important to allow enough time for staff to carry out hygiene practices thoroughly.
耐甲氧西林金黄色葡萄球菌（MRSA）作为重症监护病房（ICU）中医院获得性病原体的报道日益增多。医护人员卫生措施应用不一致在很大程度上导致了此类耐药菌株的流行传播。1992年4月至1995年12月期间，我们在儿科重症监护病房（PICU）评估了一项预防MRSA传播的控制方案的效果。患者最初每周从前鼻孔和会阴样本中采集MRSA培养物，但从1994年1月起，入院时也进行培养。一经发现，所有MRSA携带者均被隔离。对医院工作人员的教育是我们方案的重要组成部分。1992年和1993年回顾性记录医院感染率，1994年和1995年前瞻性记录。比较了“方案实施前”和“方案实施后”期间的发病率。MRSA感染率从5.9降至0.8/1000患者日（PD），（P<10^(-7)）。MRSA携带率也从34%降至2%（P<10^(-9)），MRSA与所有金黄色葡萄球菌的比例从71%降至11%（P<10^(-4)）。感染总体发病率从20.1降至13.9/1000 PD（P = 0.002）仅归因于MRSA感染的减少。然而，1994年至1995年期间，尽管患者/护士比例不变，但移植患者数量显著增加。1994年至1995年期间，移植患者中由其他微生物引起的医院感染率从64.8降至33.2/1000移植PD（P = 0.009）。与此同时，我们观察到非移植患者的感染略有增加，这可能是由于总体工作量增加对那些本应具有较少医院感染风险因素的患者产生的影响。我们得出结论，实施旨在限制人际传播的感染控制措施在控制PICU中高MRSA感染率方面是有效的，但留出足够时间让工作人员彻底实施卫生措施很重要。
