重症监护病房患者MRSA定植情况及影响因素研究

目的研究耐甲氧西林金黄色葡萄球菌(MRSA)在重症监护病房(ICU)患者鼻腔携带定植情况及其影响因素。方法通过回顾性分析方法,对某医院ICU住院患者鼻腔棉拭子标本的检测结果进行调查与分析。结果2009年7月1日至2010年6月30日期间,该医院检测ICU入院24 h内623例患者鼻腔棉拭子标本检测结果,检出90例MRSA定植阳性,阳性率为14.45%。单因素分析发现,患者高龄、糖尿病、急性肾衰、充血性心衰、近期手术等为MRSA定植的危险因素。多因素分析发现,糖尿病及充血性心衰为ICU病人MRSA定植的独立危险因素。结论该医院ICU入院24 h内的病人鼻腔携带MRSA者占14.45%,这种MRSA定植构成多重耐药感染主要危险因素,抵抗力低下人群是MRSA定植的独立危险因素。     

骨外伤病人耐甲氧西林金黄色葡萄球菌定植与感染的危险因素分析

[目的]探讨骨外伤病人住院期间获得耐甲氧西林金黄色葡萄球菌(MRSA)定植及感染情况,筛选危险因素。[方法]对我院骨外科病房住院病人通过直接采集病人鼻拭子等标本,运用双靶点基因扩增技术进行耐热核酸酶(NUC)基因与耐甲氧西林编码(MecA)基因检测,采用病例-对照研究方法对院内确诊MRSA定植与感染的病例,以1∶1配对予以对照,对可能影响因素先进行单因素分析,然后对单因素分析有统计学意义的变量进行逐步Logistic回归分析。[结果]从2012年1月—2014年11月共调查325例病人,其中入院前存在MRSA定植病人18例,伤口部位MRSA感染1例,共19例(5.8%);306例病人未检测出MRSA定植与感染,入院后获得MRSA定植与感染62例(20.3%),与入院前定植与感染比较,差异有统计学意义(χ2=29.3,P=0.000);手术治疗、使用多种抗生素治疗、年龄大与合并慢性疾病是影响MRSA定植和感染的危险因素。[结论]骨外伤病人MRSA感染与定植的影响因素多,其中手术治疗、使用多种抗生素、年龄大与合并慢性疾病是MRSA感染与定植的独立影响因素。     

医院散发耐甲氧西林金黄色葡萄球菌感染的护理

目的高度重视耐甲氧西林金黄色葡萄球菌感染和定植病例，有效防治耐甲氧西林金黄色葡萄球菌的流行与传播。方法对已发现的耐甲氧西林金黄色葡萄球菌阳性的病人进行有效治疗和严格消毒隔离，合理安排工作，尽量减少污染人群，严格医疗设备和医疗环境的消毒。结果11份耐甲氧西林金黄色葡萄球菌阳性病例经过有效治疗与严格消毒隔离，病情均得到了有效控制，没有在医院引发耐甲氧西林金黄色葡萄球菌感染的流行与传播。结论对于MRSA感染者或带菌者，清除来源，合理使用抗菌药物，加强环境清洁与消毒隔离的普及教育，及时总结和分析经验，是防治MRSA感染的有效方法：     

成人金黄色葡萄球菌血流感染133例的危险因素及预后分析

目的探讨133例成人金黄色葡萄球菌血流感染的相关危险因素及对患者预后的影响。方法对2013年1月-2017年12月确诊为金黄色葡萄球菌血流感染133例患者进行回顾性调查分析。结果 133例患者均系医院感染,其中36例检出耐甲氧西林金黄色葡萄球菌(MRSA),检出率为27.1%(36/133),97例检出甲氧西林敏感金黄色葡萄球菌(MSSA),检出率为72.9%(97/133)。除对甲氧苄啶-磺胺甲唑外,MRSA组对常用抗菌药物的耐药率均高于MSSA组,未发现对万古霉素、替考拉宁和利奈唑胺耐药株。MRSA组年龄≥65岁,呼吸衰竭,住院急诊,入住ICU,手术,使用有创呼吸机、导尿管、中心静脉导管显著高于MSSA组(P均0.05);MRSA组患者病死率高于MSSA组(25.0%比5.2%),差异有统计学意义(P0.05);MRSA组预后不良发生率高于MSSA组(41.7%比24.7%)(P0.05),差异有统计学意义;MRSA组总住院时间长于MSSA组(24 d比16 d),差异有统计学意义(P0.05);多因素分析结果显示:年龄≥65岁、入住ICU是预后不良的独立危险因素。结论 MRSA感染所致的病死率较MSSA高,MRSA血流感染增加患者住院时间,年龄≥65岁、入住ICU是预后不良的独立危险因素。     

神经内科5例耐甲氧西林金黄色葡萄球菌感染暴发调查

目的调查本医院神经内科5例耐甲氧西林金黄色葡萄球菌感染暴发原因,采取防控措施。方法采用现场和病历资料查看,对发生于该医院神经内科耐甲氧西林金黄色葡萄球菌感染暴发的情况进行调查。结果该医院神经内科ICU在2周内连续发生5例患者9例次医院感染,其中肺部感染5例次,其他部位感染4例次。从5例病人痰标本中均检出MRSA阳性,阳性率100%;其中有4例病人标本中同时检出铜绿假单胞菌和鲍曼不动杆菌。在5例医院感染患者中,均进行过泌尿道插管,有4例患者实施中心静脉置管,2例患者气管插管和1例气管切开呼吸机辅助呼吸。结论此次感染为一起MRSA医院感染暴发,经过积极救治和消毒隔离很快控制了感染疫情。     

金黄色葡萄球菌血流感染139例临床分析

目的了解金黄色葡萄球菌血流感染的临床特征,探讨影响预后的危险因素,为预防和控制金黄色葡萄球菌血流感染提供依据。方法回顾性研究2017年1月-2019年6月四川省人民医院金黄色葡萄球菌血流感染的病例,分析其临床特征及与预后相关的危险因素。结果共收集139例金黄色葡萄球菌血流感染病例,其中耐甲氧西林金黄色葡萄球菌(MRSA)感染39例,甲氧西林敏感的金黄色葡萄球菌(MSSA)感染100例。MRSA组入住ICU(P=0.035)、合并多种细菌感染(P=0.020)和进行机械通气者(P=0.043)多于MSSA组,且MRSA组的住院时间、病死率及住院费用均明显高于MSSA组,差异有统计学意义(P0.05)。MRSA组对多数抗菌药物的耐药率高于MSSA组,未发现对万古霉素、利奈唑胺和替加环素耐药的金黄色葡萄球菌菌株。多因素分析结果显示,入住ICU、MRSA感染和机械通气是死亡的独立危险因素。结论 MRSA感染患者病死率高、住院时间长并住院费用高,且MRSA血流感染是患者死亡的危险因素。     

骨科术后金黄色葡萄球菌感染的病原菌分布及危险因素分析

目的探讨骨科术后金黄色葡萄球菌感染的病原菌分布及相关危险因素。方法选取骨科行手术治疗的863例患者,对金黄色葡萄球菌感染患者手术切口分泌物进行培养,分析病原菌分布及相关危险因素,并提出相关预防措施。结果 863例骨科手术患者术后金黄色葡萄球菌感染23例,感染率为2.67%,共培养出病原菌23株,其中耐甲氧西林金黄色葡萄球菌(MRSA)13株,甲氧西林敏感金黄色葡萄球菌(MSSA)10株。单因素分析发现,骨科术后切口金黄色葡萄球菌感染与骨折类型、切口类型、手术时间、应用抗生素种类及合并糖尿病有关(P0.05)。Logistic多元回归分析显示,开放性骨折、手术时间2h、Ⅲ类切口、应用抗生素种类3种是骨科术后金黄色葡萄球菌感染的危险因素。结论骨科术后金黄色葡萄球菌感染以MRSA为主,骨科医生应密切关注相关危险因素,预防感染发生。     

耐甲氧西林金黄色葡萄球菌临床分布特征及护理研究

目的分析耐甲氧西林金黄色葡萄球菌在临床的分布特征,为研究降低医院耐甲氧西林金黄色葡萄球菌感染发生率的护理及防控措施提供依据。方法回顾性分析2010年1月~2015年6月本院检出的103例耐甲氧西林金黄色葡萄球菌感染患者,并对分离菌株的来源科室和患者感染部位等进行统计分析。结果共检出的103例耐甲氧西林金黄色葡萄球菌感染患者科室分布由多到少依次为重症医学中心(29例)、呼吸内科(26例)、肾内科(15例)、脑外科(12例)、神经内科(9例)、心胸外科(6例),以及其它科室(6例);感染部位由多至少依次为呼吸道(37例)、泌尿道(24例)、心导管相关性(10例)、浅表伤口和溃疡(9例)、导尿管(8例)、眼及耳部(8例)、深部伤口(5例)、手术切口(1例)以及脑脊液(1例),各病区耐甲氧西林金黄色葡萄球菌检出率存在明显的差别(P0.01),感染部位分布也有明显差异(P0.01)。结论有效隔离耐甲氧西林金黄色葡萄球菌感染者,重视重点科室患者的消毒、隔离护理是有效预防和控制耐甲氧西林金黄色葡萄球菌感染的关键。     

耐甲氧西林金黄色葡萄球菌血流感染死亡患者临床特征及危险因素分析

目的 分析耐甲氧西林金黄色葡萄球菌(MRSA)血流感染患者临床特征及预后危险因素,为控制和预防MRSA血流感染提供依据.方法 回顾性分析2015年1月—2020年12月南京医科大学第一附属医院门诊及住院血液培养MRSA阳性患者临床特征和预后危险因素.结果 142例MRSA血流感染患者以男性、老年为主,生存99例,死亡4...     

感染性单核细胞增多症合并CA-MRSA感染1例报道

来自于社区的既往从未接触过医疗场所的患者,出现耐甲氧西林的金黄色葡萄球菌(MRSA)感染,定义为社区获得性MRSA.但感染性单核细胞增多症(IM)患者合并社区获得性耐甲氧西林的金黄色葡萄球菌(CA-MRSA)感染,国内外尚无报道.现将1例住院患者报道如下.     

Methicillin-resistant Staphylococcus aureus infection in palliative care

Our objective was to assess the impact of methicillin-resistant Staphylococcus aureus (MRSA) infection in palliative care. The study was conducted at three hospices in south London, totalling 118 beds, and the following two methods were used. Firstly, a retrospective review of the notes of patients who were known to be MRSA positive at admission or were subsequently found to be MRSA positive was taken. Secondly, a prospective study of factors influencing bed occupancy in one hospice was conducted. The proportion of admissions who were MRSA positive ranged from 4% to 8% in the three hospices. Seven of the 43 patients who had MRSA suffered clinically significant infections. Risk factors for colonization and bacteraemia were similar to the general population. Sites of infection were variable and multiple and treatment regimes for eradication were variable, with varying outcomes. MRSA infection appeared to delay admission because of the need for single rooms, of which there are few Time spent cleaning rooms after discharge or death also reduced the number of available beds. It was concluded that MRSA infection is associated with significant morbidity in a small number of palliative care patients. Beds unavailable because of MRSA should be considered in bed occupancy figures, otherwise bed occupancy may appear artificially low. The psychological and financial impact of the infection in palliative care patients needs further evaluation.     

Successful long-term program for controlling methicillin-resistant Staphylococcus aureus in intensive care units

Objective To evaluate the effectiveness of screening strategy and contact precautions for patients with methicillin-resistant Staphylococcus aureus (MRSA).Design and setting Prospective observational cohort from 1 February 1995 to 31 December 2001 in three intensive care units (45 beds) in a French teaching hospital.Patients 8,548 patients admitted to the three ICUs had nasal screening on ICU admission and weekly thereafter. Contact precautions were used in MRSA-positive patients. The following variables were collected: age, gender, severity score, length of stay, workload, and colonization pressure (percentage of patient-days with an MRSA to the number of patient-days in the unit). Alcohol-based handrub solution was introduced in July 2000. We compared the period before this (P1) with that thereafter (P2).Results Of the 8,548 admitted patients 554 (6.5%) had MRSA at ICU admission, and 456 of the 7,515 (6.1%) exposed patients acquired MRSA. Acquisition incidence decreased from 7.0% in P1 to 2.8% in P2. Independent variables associated with MRSA acquisition were: age (adjusted odds ratio 1.013), severity score (1.047), length of ICU stay (1.015), colonization pressure (1.019), medical ICU (1.58), and P2 (0.49).Conclusions MRSA control in these ICUs characterized by a high prevalence of MRSA at admission was achieved via multiple factors, including screening, contact precautions, and use of alcoholic handrub solution. Our results after adjustment of risk factors for MRSA acquisition and the steady improvement in MRSA over several years strengthen these findings. MRSA spreading can be successfully controlled in ICUs with high colonization pressure.     

Carriage of methicillin-resistant Staphylococcus aureus on admission to European rehabilitation centres--a prospective study

This study aimed to determine the prevalence of and risk factors for methicillin-resistant Staphylococcus aureus (MRSA) carriage among patients newly admitted to rehabilitation centres. It is a prospective study examining MRSA carriage on admission to seven rehabilitation wards in four countries. Risk factors for MRSA carriage were analysed using univariate and multivariate analyses. A total of 1204 patients were studied. Among them, 105 (8.7%) had a positive admission MRSA screening result. The MRSA carriers were more likely to be male, to have had a recent stay in another long-term-care facility or >2 weeks acute-care hospital stay, history of colonization with MRSA, reduced level of consciousness, peripheral vascular disease and pressure sores. In multivariable logistic regression male gender (odds ratio (OR) 2.2, 95% confidence interval (CI) 1.4-3.6, p 0.001), history of MRSA positivity (OR 6.8, 95% CI 3.8-12.3, p <0.001), peripheral vascular disease (OR 2.5, 95% CI 1.2-5, p 0.013), recent stay in another long-term-care facility (OR 2.1, 95% CI 1.3-3.5, p 0.004), or long (>2 weeks) acute-care hospital stay (OR 1.9, 95% CI 1.2-3, p 0.004), remained significant risk factors for MRSA carriage. MRSA carriage is common on admission to rehabilitation centres but less so, than previously described in long-term-care facilities. Male gender, history of MRSA positivity, previous hospitalization and peripheral vascular disease may predict MRSA carriage, and may serve as indicators for using pre-emptive infection control measures.     

Performance of surveillance cultures at different body sites to identify asymptomatic Staphylococcus aureus carriers

The objective was to evaluate the performance of surveillance cultures at various body sites for Staphylococcus aureus colonization in pregnant women and newborns (NB) and the factors associated with nasal colonization. For NB, 4 sites were evaluated: nares, oropharynx, perineum, and umbilical stump (birth, third day, and weekly). For pregnant women, 4 sites during labor: anterior nares, anus, perineum, and oropharynx. Nasally colonized patients were compared with colonized only extranasally. Colonization was 53% of 392 pregnant women (methicillin-resistant S. aureus [MRSA]: 4%) and 47% of 382 NB (MRSA: 9%). For newborn patients, the best body site was the umbilical stump (methicillin-susceptible S. aureus [MSSA]: 64%; MRSA: 68%) and the combination of nares + umbilical (MSSA: 86%; MRSA: 91%). Among pregnant women, the best body site was the anterior nares (MSSA: 59%; MRSA: 67%) and the combination of nares + oropharynx (MSSA: 83%; MRSA: 80%). A smaller number of household members were associated with MRSA carriage in pregnant women (2.2 ± 0.6 versus 3.6 ± 1.8; P = 0.04). In conclusion, multiple culture sites are needed. Control programs based on surveillance cultures may be compromised.     

Dual-site sampling improved detection rates for MRSA colonization in patients with cutaneous abscesses

Extranasal sites are common reservoirs of Staphylococcus aureus colonization and may be relevant for methicillin-resistant S. aureus (MRSA) screening and infection control strategies. The objective here was to determine whether inguinal specimens could also be screened using Xpert SA Nasal Complete assay for MRSA. Results were compared to broth enrichment culture. Among 162 consented adults seeking care in the emergency department for cutaneous abscesses, inguinal specimens were found positive for MRSA more often than nares specimens, 24% and 26% by PCR or culture, respectively, compared to 19% each by PCR or culture. Overall, 6% of adults colonized with MRSA would have been missed by nares screening alone. Compared to culture, Xpert SA Nasal Complete assay demonstrated sensitivity and specificity of 89% and 97%, respectively, for detecting nares and/or inguinal MRSA colonization. In conclusion, inguinal specimens were a more common reservoir for MRSA than nares specimens in this population of patients.     

Concordance of nasal and diabetic foot ulcer staphylococcal colonization

Nasal carriage of Staphylococcus aureus (SA) is an important risk factor for surgical site infections. The goal of this study was to investigate the concordance between nasal and diabetic foot ulcer (DFU) SA carriage. Seventy-nine subjects with DFUs were assessed for nasal and DFU colonization with SA, including methicillin-resistant SA (MRSA). Twenty-five (31.6%) subjects had nares colonization with SA; 29 (36.7%) had DFU colonization with SA. Seven (8.8%) subjects had nares colonization with MRSA, and 7 (8.8%) had DFU colonization with MRSA. Ulcer duration was associated with MRSA presence (P = 0.01). Sensitivity and specificity of positive nasal SA colonization with positive DFU colonization were 41% and 74%. We found substantial discordance between SA strains colonizing DFU and the nasal cavity. The poor positive predictive values for SA isolation in a DFU based on nasal carriage suggests that SA colonization of a DFU by endogenous SA strains cannot be assumed.     

医院MRSA感染危险因素分析

目的分析医院耐甲氧西林金黄色葡萄球菌(MRSA)感染危险的因素,以便采取有效措施降低感染率。方法对各科室送检标本实施MRSA菌株分离,然后采用1∶1成组病例对照选取非医院MRSA感染患者60例,并与60例医院MRSA感染患者料进行单因素分析、多因素研究分析。结果单因素分析结果显示高龄、住院时间长、抗生素使用超过2种、广谱抗菌药使用时间超过7 d、侵入性操作超过2项等因素与医院MRSA感染有关。多因素分析结果显示医院MRSA感染的危险因素主要有住院时间长、侵入性操作超过2项、广谱抗菌药使用时间超过7 d和抗生素使用超过2种。结论侵入性操作、长时间住院、光谱抗菌药长时间使用和抗菌药的不合理应用是医院MRSA感染的危险因素。     

Throat and rectal swabs may have an important role in MRSA screening of critically ill patients

OBJECTIVE: Methicillin-resistant Staphylococcus aureus (MRSA) is a major problem in intensive care units (ICU). International guidelines recommend screening patients for MRSA on admission, although consensus on sites required for optimum detection has not been reached. Our aim was to determine whether throat and rectal swabs identified a significant number of additional MRSA-colonised patients not captured by swabbing at keratinized skin carriage sites (anterior nares, perineum and axillae). DESIGN: Prospective cohort study. SETTING: 30-Bed medical and surgical ICU in a tertiary teaching hospital. PATIENTS: One thousand four hundred and eighty adult patients consecutively admitted over 15 months. MEASUREMENTS AND RESULTS: Swabs from carriage sites (anterior nares, perineum, axillae, throat and rectum), wounds and clinical samples taken within 48 h of ICU admission were analysed to identify patients admitted with MRSA. A complete set of carriage swabs were received from 1,470 patients. 105 (7%) patients were admitted with MRSA of which 63 (60%) were detected by a pooled keratinized skin swab (anterior nares, perineum, axillae). A further 36 (34%) patients were detected only by throat or rectal swabs. Indeed, throat and rectal swabs combined had a higher sensitivity than pooled keratinised skin swabs (76 vs. 60% P = 0.0247). Swabs from all carriage sites together detected 95% (100) of MRSA positive patients, with five patients being positive at wound sites only. CONCLUSIONS: The throat and rectum are important and potentially hidden sites of MRSA carriage in critically ill patients. These findings prompt the need for larger studies to determine the most cost-effective screening strategy for MRSA detection. DESCRIPTOR: Non-pulmonary nosocomial infections.     

Staphylococcus aureus colonization in community-dwelling people with spinal cord dysfunction

OBJECTIVES: To estimate the prevalence of and determine risk factors for Staphylococcus aureus colonization of the perineum. DESIGN: Cross-sectional study with follow-up of up to 1 year. SETTING: Multiple outpatient sites. PARTICIPANTS: Eighty-four community-dwelling adults with spinal cord dysfunction (SCD). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Colonization of perineum with S. aureus. RESULTS: Overall, 24% of the study cohort carried S. aureus on their perineal skin at enrollment, with 16% having methicillin-susceptible S. aureus and 10% having methicillin-resistant S. aureus (MRSA). Most perineal carriers were also colonized in the anterior nares. Participants with trauma as the cause of their SCD were more likely to be colonized with S. aureus than participants with SCD caused by multiple sclerosis or other causes (relative risk [RR], 2.8; 95% confidence interval [CI], 1.2-6.6; P=.01). Participants with pelvic decubiti were more likely to be colonized with S. aureus than participants without pelvic decubiti (RR=4.3; 95% CI, 2.4-7.7; P<.001). The recent use of any antibiotic was not associated with an increased risk of colonization with S. aureus (RR=1.5; 95% CI, 0.7-3.3; P=.31); however, recent fluoroquinolone use was significantly associated with perineal colonization (RR=2.8; 95% CI, 1.4-5.8; P=.02). Of the 8 participants with MRSA colonization, only 2 (25%) had a history of MRSA colonization. CONCLUSIONS: S. aureus colonization of the perineum is common in this outpatient population of people with SCD. The use of fluoroquinolones was associated with S. aureus colonization. Colonization with MRSA without a history of MRSA was common.     

Prevalence of methicillin-resistant Staphylococcus aureus based on culture and PCR in inpatients at a tertiary care center in Tokyo, Japan

We investigated active screening for colonization with methicillin-resistant Staphylococcus aureus (MRSA) on admission and weekly follow-up surveillance after admission to a tertiary care center (TCC) between June 2007 and 31 December 2007. Eleven percent (30/267) of patients were found to be positive for MRSA by polymerase chain reaction (PCR) and/or culture on admission; 5% (12/267) became positive during the TCC stay. The major primary diagnoses in MRSA-positive patients were pneumonia and cerebrovascular diseases. Twenty-two (52%) of 42 patients were found to be MRSA positive by both PCR and culture, compared with 19 (45%) of 42 who were PCR positive and culture negative. These findings suggest that active surveillance with PCR is highly sensitive and useful for the detection of MRSA colonization. To our knowledge, this is the first report of active surveillance of MRSA by PCR and bacterial culture in critically ill inpatients in Japan.