JAMA:入院MRSA筛检与减少感染率无关

据3月12日《美国医学协会期刊》（JAMA）上的一则研究显示，新的发现不支持对所有病人在入院时进行甲氧苯青霉素耐药性金黄色葡萄球菌（MRSA）筛检来减少外科病人医院内感染发生率的建议。

瑞士日内瓦大学医院的Stephan Harbarth及其同僚开展了一项研究，旨在评估MRSA早期发现的策略对医院内MRSA感染率的影响。该项研究是在一家瑞士的教学医院中的2万1754名外科病人中进行的。研究人员采用了2种控制MRSA的策略，即在入院时对病人进行快速筛检加上标准化的控制感染方法，以及仅仅采用标准化的控制感染方法。

在该项研究期间，对病人入院时进行筛检发现了总数为515名的MRSA-阳性病患（占被筛检病人的5.1%），其中大部分的筛检阳性病人(n = 337 [65%])过去没有被确诊为MRSA携带者，因此他们在入院时如果不进行系统筛检的话将不会被发现。本文的作者估计，要发现一名在入院时从前未被发现的MRSA携带者，需要筛检30名入院的病人。

在治疗干预期间，共有93名病人（相当于每1000名病人-天中有1.11人）得了医院内MRSA感染，而在对照期间得了医院内MRSA感染的病人人数为76人（相当于每1000名病人-天中有0.91人）。MRSA在外科部门的感染率以及医院内MRSA感染都没有发生显著的变化。在外科病房内，93名感染的病人中有53人（占57%）在入院时没有携带MRSA，但他们在住院时感染了MRSA。（来源：EurekAlert!中文版）

生物谷推荐原始出处：

（JAMA），2008;299(10):1149-1157，Stephan Harbarth，Didier Pittet

Universal Screening for Methicillin-Resistant Staphylococcus aureus at Hospital Admission and Nosocomial Infection in Surgical Patients

Stephan Harbarth, MD, MS; Carolina Fankhauser, MS; Jacques Schrenzel, MD; Jan Christenson, MD; Pascal Gervaz, MD; Catherine Bandiera-Clerc, RN; Gesuele Renzi, MS; Nathalie Vernaz, PharmD; Hugo Sax, MD; Didier Pittet, MD,

Context Experts and policy makers have repeatedly called for universal screening at hospital admission to reduce nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection.

Objective To determine the effect of an early MRSA detection strategy on nosocomial MRSA infection rates in surgical patients.

Design, Setting, and Patients Prospective, interventional cohort study conducted between July 2004 and May 2006 among 21 754 surgical patients at a Swiss teaching hospital using a crossover design to compare 2 MRSA control strategies (rapid screening on admission plus standard infection control measures vs standard infection control alone). Twelve surgical wards including different surgical specialties were enrolled according to a prespecified agenda, assigned to either the control or intervention group for a 9-month period, then switched over to the other group for a further 9 months.

Interventions During the rapid screening intervention periods, patients admitted to the intervention wards for more than 24 hours were screened before or on admission by rapid, multiplex polymerase chain reaction. For both intervention (n=10 844) and control (n=10 910) periods, standard infection control measures were used for patients with MRSA in all wards and consisted of contact isolation of MRSA carriers, use of dedicated material (eg, gown, gloves, mask if indicated), adjustment of perioperative antibiotic prophylaxis of MRSA carriers, computerized MRSA alert system, and topical decolonization (nasal mupirocin ointment and chlorhexidine body washing) for 5 days.

Main Outcome Measures Incidence of nosocomial MRSA infection, MRSA surgical site infection, and rates of nosocomial acquisition of MRSA.

Results Overall, 10 193 of 10 844 patients (94%) were screened during the intervention periods. Screening identified 515 MRSA-positive patients (5.1%), including 337 previously unknown MRSA carriers. Median time from screening to notification of test results was 22.5 hours (interquartile range, 12.2-28.2 hours). In the intervention periods, 93 patients (1.11 per 1000 patient-days) developed nosocomial MRSA infection compared with 76 in the control periods (0.91 per 1000 patient-days; adjusted incidence rate ratio, 1.20; 95% confidence interval, 0.85-1.69; P = .29). The rate of MRSA surgical site infection and nosocomial MRSA acquisition did not change significantly. Fifty-three of 93 infected patients (57%) in the intervention wards were MRSA-free on admission and developed MRSA infection during hospitalization.

Conclusion A universal, rapid MRSA admission screening strategy did not reduce nosocomial MRSA infection in a surgical department with endemic MRSA prevalence but relatively low rates of MRSA infection.