MRSA定植及感染实时监测的暴发案例分析研究

目的分析对某大医院神经内科病房中耐甲氧西林金黄色葡萄球菌（MRSA）患者定植及感染的实时监测中暴发案例，推断MRSA传播途径并及时调整干预。方法采用前瞻性监测设计，对住院患者进行MRSA定植及感染的定期筛查，同期收集医护人员鼻前庭及手部标本并观察医护人员手卫生执行情况。IRS-PCR基因分型法对分离的MRSA菌株进行同源性分析。结果在07年10月至11月间，MRSA的定植或感染率为5％，其中入院后MRSA的定植或感染为4％；呈现暴发。同期医护人员手卫生总执行率为15．9％。对该期间住院患者临床标本、鼻前庭标本及医护人员手标本分离的共10株MRSA菌株进行IRS—PCR同源性分析，结果为同一亚型。并且，及时提出严格监督手卫生、护理MRSA阳性病人的医护分组、调整隔离病房等干预措施，制止了此次MRSA的进一步扩散。结论我们推断医护人员的手部是MRSA的暴发流行传播过程中的关键因素。并且开展MRSA的现场实时监测，对及时提出针对性的干预措施具有极大的借荐作用。

Study on an outbreak of methicillin-resistant Staphylococcus aureus in Real-Time monitoring of Colonization and infection

Objective To study an outbreak of Methicillin-resistant Staphylococcus aureus （MRSA） colonization and infection a- mong inpatients, route of transmission and intervention measure. Methods A prospective investigation was applied. The MRSA strains isolated from inpatients and health care workers （HCWs） were collected during the study.The condition of the contact between inpatients and HCWs were recorded during the study.The genes of the isolated MRSA strains were amplified by Infrequent-restriction-site PCR （IRS-PCR） assay. Results From October to November in 2007, the total colonization and infection rate of MRSA was 5 %, the acquired colonization and infection rate was 4 %. The average hand hygiene compliance was 15.9 %. 1RS-PCR assay revealed high homology between the MRSA strains isolated from inpatients and H CWs. A serious outbreak of MRSA has been prevented when the inpatients colonized or infected has been isolated and the average hand hygiene compliance has been monitored. Conclusion Hands of HCWs is a risk factor for outbreak of MRSA in nosocomial infection. A real-time monitering of MRSA will offer great help to institute intervention measure.