文摘翻译有奖（2010年国外医院感染相关杂志）

gemao

美国感染控制杂志2010年第4期
53、哥伦比亚社区相关MRSA引起的医院感染
背景：社区相关的耐甲氧西林金黄色葡萄球菌（CA-MRSA）已经作为健康机构相关感染的致病因素出现。
方法：在哥伦比亚波哥大的5家医院中进行的观察和前瞻性的研究，发现严重的MRSA感染，将其来源分为健康护理相关性感染，社区相关性感染和医院感染。对MRSA的菌株进行SCCmec, 脉冲凝胶电泳, 多核心序列印迹, 和毒力因素的分析。
结果：
在250例MRSA 感染标本中分离出26例造成CA-MRSA 医院感染的菌株 (如, USA300)，主要发生在原发性菌血症和手术部位感染。与CA-MRSA相关的医院感染死亡率是27%。
结论：在哥伦比亚存在CA-MRSA的医院感染得到证实。

gemao

美国感染控制杂志2010年第4期
49、迟发型B族链球菌感染爆发
背景：2007年，田纳西卫生部门注意到一组由迟发型B组链球菌（GBS）引发的新生儿重症监护室感染。迟发型GBS的爆发通常是罕见的。
方法：在2007年9月6日在一名出生超过7天的新生儿中发现，经培养确认委侵入性GBS感染，在医院中， 我们回顾了医疗记录，检查NICU的微生物学报告，进行血清学检查，对侵入性标本进行脉冲凝胶电泳分析和多核心序列印迹分析。回顾母亲的GBS筛选、预防和感染控制政策，观察医务人员的操作。
结果  发现5例迟发型GBS感染。没有一例母亲和婴儿接受适当的GBS预防措施。从病人中分离出2个血清型，3个PFGE模式，和2个MLST模式。3例标本不能分辨亚型。这3例及时集中（隔离）。发现没有共同的健康提供者。在NICU 中发现感染控制出现偏差。
结论 我们发现一组5例多克隆的迟发型GBS，，多种因素造成此次爆发，包括医院GBS的传播。需要进一步努力防止迟发型GBS的爆发。

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美国感染控制杂志2010年第4期
(已翻译）54、Educational intervention, revised instrument sterilization methods, and comprehensive preoperative skin preparation protocol reduce cesarean section surgical site infections降低剖腹产后手术部位感染的措施
Background
In 2005, of the approximately 4 million births in the United States, 30% were by cesarean section (C-section) delivery, which translates to roughly over 1 million C-sections in 2005 alone. C-section is associated with higher morbidity than vaginal delivery. Women who undergo C-section are 5 times more likely to develop a postpartum infection after delivery than women who undergo vaginal delivery.

Objective
Estimates of surgical site infection (SSI) after C-section range from 1.50 to 2.64. A quality improvement initiative was implemented at the University of Minnesota Medical School to reduce rates of SSI using changes based on recommended care initiatives.

Methods
The multidisciplinary team developed a comprehensive staff education and training program, added a preoperative skin preparation protocol using chlorhexidine gluconate (CHG) no-rinse cloths, added CHG with alcohol for interoperative skin preparation, and modified instrument sterilization techniques.

Results
Data analysis revealed a statistically significant reduction in the overall SSI rate from 7.5% (33/441) in January-July 2006 to 1.2% (5/436) in January-July 2007 (χ2 test statistic, 21.2; P < .001; relative reduction of 84%).

Conclusion
Interventions, including staff education, use of CHG no-rinse cloths for preoperative skin prep, CHG with alcohol for intraoperative skin prep, and appropriate instrument sterilization management led to reductions in SSI rates in patients undergoing C-section at our institution. Rates of endometritis were also noted to be lower after implementation of the interventions.

Key Words: Surgical site infections, obstetrical surgical site infections, C-section surgical site infections, chlorhexidine gluconate skin preparation

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美国感染控制杂志2010年第4期
55、The impact of portable high-efficiency particulate air filters on the incidence of invasive aspergillosis in a large acute tertiary-care hospital手持式高效过滤器对侵入性曲霉菌感染的影响
Background
Worldwide, the frequency of invasive fungal infections has been increasing, with a corresponding increase in the numbers of high-risk patients. Exposure reduction through the use of high-efficiency particulate air (HEPA) filters has been the preferred primary preventive strategy for these high-risk patients. Although the efficiency and benefits of fixed HEPA filters is well proven, the benefits of portable HEPA filters are still inconclusive.

Methods
This was a retrospective study to assess the impact of 48 portable HEPA filter units deployed in selected wards in Singapore General Hospital, an acute tertiary-care hospital in Singapore. Data were extracted between December 2005 and June 2008 on the diagnoses at discharge and microbiological and histological laboratory findings. All patients with possible, probable, or proven invasive aspergillosis (IA) were included.

Results
In wards with portable HEPA filters, the incidence rate of IA of 34.61/100,000 patient-days in the preinstallation period was reduced to 17.51/100,000 patient-days in the postinstallation period (P = .01), for an incidence rate ratio of 1.98 (95% confidence interval [CI], 1.10-2.97). In wards with no HEPA filters, there was no significant change in the incidence rate during the study period. Portable HEPA filters were associated with an adjusted odds ratio of 0.49 (95% CI, 0.28-0.85; P = .01), adjusted for diagnosis and length of hospital stay.

Conclusions
Portable HEPA filters are effective in the prevention of IA. The cost of widespread portable HEPA filtration in hospitals will be more than offset by the decreases in nosocomial infections in general and in IA in particular.

Key Words: Invasive aspergillosis, high-efficiency particulate air filter, invasive fungal infection

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美国感染控制杂志2010年第4期
56、Eight years of active proposal of pneumococcal 23-valent polysaccharide vaccine: Survey on coverage rate among elderly and chronic patients老年人和慢性病患者肺炎疫苗接种调查Background

Streptococcus pneumoniae, lancet-shaped, gram-positive, facultative anaerobic organisms, are common inhabitants of the respiratory tract and may be isolated from the nasopharynx of 5% to 70% of healthy adults.

Objective

The aims of the study were to estimate the vaccination coverage for pneumococcal 23-valent polysaccharide vaccine and to assess the impact its introduction in the Italian region of Puglia, where a program to provide this vaccination has been operative since 2000.

Methods

Estimation of the coverage for pneumococcal 23-valent polysaccharide vaccine was implemented by a 2-step study consisting of data collection from local health unit vaccination registers between 2000 and 2008 in Puglia and of a cluster sampling study among general practitioners to validate routine data collected during the first step. Moreover, hospitalization for invasive pneumococcal diseases was studied.

Results

From 2000 to 2004, among individuals ≥65 years, the overall coverage rate estimated by routine data amounted to 26.3%; between 2005 and 2007, annual coverage rates did not exceed 8%/year. Between 2002 and 2007, the overall coverage rate estimated by interviewing general practitioners was 46.6% (95% confidence interval: 39.9-53.4). The coverage rate in chronic patients by routine data was approximately 23%, whereas the rate provided by general practitioners was 17.6% (95% confidence interval: 12.5-22.8). From 2001 to 2007, hospitalization data did not show a reduction in invasive pneumococcal disease trends among the elderly population in Puglia.

Conclusion

The results of this study demonstrate the need for improving vaccine coverage and implementing new immunization strategies and practices.

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美国感染控制杂志2010年第4期
57、Evaluation of biologic occupational risk control practices: Quality indicators development and validation生物安全职业暴露控制措施评价Background
There is growing demand for the adoption of qualification systems for health care practices. This study is aimed at describing the development and validation of indicators for evaluation of biologic occupational risk control programs.

Methods
The study involved 3 stages: (1) setting up a research team, (2) development of indicators, and (3) validation of the indicators by a team of specialists recruited to validate each attribute of the developed indicators. The content validation method was used for the validation, and a psychometric scale was developed for the specialists' assessment. A consensus technique was used, and every attribute that obtained a Content Validity Index of at least 0.75 was approved.

Results
Eight indicators were developed for the evaluation of the biologic occupational risk prevention program, with emphasis on accidents caused by sharp instruments and occupational tuberculosis prevention. The indicators included evaluation of the structure, process, and results at the prevention and biologic risk control levels. The majority of indicators achieved a favorable consensus regarding all validated attributes.

Conclusion
The developed indicators were considered validated, and the method used for construction and validation proved to be effective.

gemao

美国感染控制杂志2010年第4期降低剖腹产后手术部位感染的措施
背景：在2005年，美国有将近400万例出生，其中30％采用剖腹产，这样大约在2005年有超过100万例的剖腹产。剖腹产比阴道分娩具有更高的感染发病率。剖腹产后感染的妇女是经阴道分娩妇女的5倍。
目的：剖腹产后手术部位感染（SSI）率的范围从1.5－2.64。在明尼苏达医学院贯彻质量改善倡议，使用根据推荐的护理倡议来减少SSI率。
方法：多学科团队建立全面的工作人员教育和训练项目，增加使用含洗必泰 CHG不漂洗布做术前皮肤准备协议，增加含酒精的CHG用于术中皮肤准备，修改设备消毒技术。
结果：数据分析显示整体SSI率明显减少，从2006年1－7月的7.5％，下降到2007年1－7月的1.2％，(χ2 检验统计, 21.2; P < .001;，相对减少84％。)
结论：包括职员的的教育，使用含洗必泰（CHG）的不漂洗布进行术前皮肤准备，含酒精的CHG 用于术中皮肤准备，和器械的适当消毒管理等干预措施减少了此医疗机构的剖腹产后病人的手术部位感染。还注意到，在贯彻干预措施后，子宫内膜异位症率也下降。

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美国感染控制与流行病学杂志2010年第6期
(已翻译）58、Prevalence and Characteristics of Staphylococcus aureus Colonization among Healthcare Professionals in an Urban Teaching Hospital专业保健人员金葡菌定植的流行病学特征
Objective.To determine the prevalence of asymptomatic carriage of Staphylococcus aureus and methicillin‐resistant S. aureus (MRSA) among healthcare professionals (HCPs) who experience varying degrees of exposure to ambulatory patients and to genetically characterize isolates.

Methods.This single‐center, cross‐sectional study enrolled 256 staff from the intensive care units, emergency department, and prehospital services of an urban tertiary care university hospital in 2008. Occupational histories and nasal samples for S. aureus cultures were obtained. S. aureus isolates were genetically characterized with the use of spa typing and screened for mecA. MRSA isolates underwent further characterization.

Results.S. aureus was isolated from 112 of 256 (43.8%) HCPs, including 30 of 52 (57.7%) paramedics, 51 of 124 (41.1%) nurses, 11 of 28 (39.3%) clerical workers, and 20 of 52 (38.5%) physicians. MRSA was isolated from 17 (6.6%) HCPs, including 1 (1.9%) paramedic, 13 (10.5%) nurses, 1 (3.6%) clerical worker, and 2 (3.8%) physicians. Among S. aureus isolates, 15.2% were MRSA. MRSA prevalence was 9.6% (12/125) in emergency department workers, 5.1% (4/79) in intensive care unit workers, and 1.9% (1/52) in emergency medical services workers. Compared with paramedics, who had the lowest prevalence of methicillin resistance among S. aureus isolates (1 of 30 [3.3%] isolates), nurses, who had the highest prevalence (13 of 51 [25.4%] isolates), had an odds ratio of 9.92 (95% confidence interval, 1.32–435.86;P=0.02  ) for methicillin resistance. Analysis of 15 MRSA isolates revealed 7 USA100 strains, 6 USA300 strains, 1 USA800 strain, and 1 EMRSA‐15 strain. All USA300 strains were isolated from emergency department personnel.

Conclusions.The observed prevalence of S. aureus and MRSA colonization among HCPs exceeds previously reported prevalences in the general population. The proportion of community‐associated MRSA among all MRSA in this colonized HCP cohort reflects the distribution of the USA300 community‐associated strain observed increasingly among US hospitalized patients.

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美国感染控制与流行病学杂志2010年第6期
（已翻译）59、Staphylococcus aureus Nasal Colonization and Subsequent Infection in Intensive Care Unit Patients: Does Methicillin Resistance Matter?金葡菌鼻腔定植与ICU病人继发感染
Background.Staphylococcus aureus is an important cause of infection in intensive care unit (ICU) patients. Colonization with methicillin‐resistant S. aureus (MRSA) is a risk factor for subsequent S. aureus infection. However, MRSA‐colonized patients may have more comorbidities than methicillin‐susceptible S. aureus (MSSA)–colonized or noncolonized patients and therefore may be more susceptible to infection on that basis.

Objective.To determine whether MRSA‐colonized patients who are admitted to medical and surgical ICUs are more likely to develop any S. aureus infection in the ICU, compared with patients colonized with MSSA or not colonized with S. aureus, independent of predisposing patient risk factors.

Design.Prospective cohort study.

Setting.A 24‐bed surgical ICU and a 19‐bed medical ICU of a 1,252‐bed, academic hospital.

Patients.A total of 9,523 patients for whom nasal swab samples were cultured for S. aureus at ICU admission during the period from December 2002 through August 2007.

Methods.Patients in the ICU for more than 48 hours were examined for an ICU‐acquired S. aureus infection, defined as development of S. aureus infection more than 48 hours after ICU admission.

Results.S. aureus colonization was present at admission for 1,433 (27.8%) of 5,161 patients (674 [47.0%] with MRSA and 759 [53.0%] with MSSA). An ICU‐acquired S. aureus infection developed in 113 (2.19%) patients, of whom 75 (66.4%) had an infection due to MRSA. Risk factors associated with an ICU‐acquired S. aureus infection included MRSA colonization at admission (adjusted hazard ratio, 4.70 [95% confidence interval, 3.07–7.21]) and MSSA colonization at admission (adjusted hazard ratio, 2.47 [95% confidence interval, 1.52–4.01]).

Conclusion.ICU patients colonized with S. aureus were at greater risk of developing a S. aureus infection in the ICU. Even after adjusting for patient‐specific risk factors, MRSA‐colonized patients were more likely to develop S. aureus infection, compared with MSSA‐colonized or noncolonized patients.

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美国感染控制与流行病学杂志2010年第6期
（已翻译）60、Quantitative Analysis and Molecular Fingerprinting of Methicillin‐Resistant Staphylococcus aureus Nasal Colonization in Different Patient Populations: A Prospective, Multicenter Study不同病人MRSA鼻腔定植分子指纹分析的多中心研究
Objectives.To better understand the prevalence of methicillin‐resistant Staphylococcus aureus (MRSA) colonization or infection in different patient populations, to perform quantitative analysis of MRSA in nasal cultures, and to characterize strains using molecular fingerprinting.

Design.Prospective, multicenter study.

Setting.Eleven different inpatient and outpatient healthcare facilities.

Participants.MRSA‐positive inpatients identified in an active surveillance program; inpatients and outpatients receiving hemodialysis; inpatients and outpatients with human immunodeficiency virus (HIV) infection; patients requiring cardiac surgery; and elderly patients requiring long‐term care.

Methods.Nasal swab samples were obtained from January 23, 2006, through July 27, 2007; MRSA strains were quantified and characterized by molecular fingerprinting.

Results.A total of 444 nares swab specimens yielded MRSA (geometric mean quantity, 794 CFU per swab; range, 3–15,000,000 CFU per swab). MRSA prevalence was 20% for elderly residents of long‐term care facilities (25 of 125 residents), 16% for HIV‐infected outpatients (78 of 494 outpatients), 15% for outpatients receiving hemodialysis (31 of 208 outpatients), 14% for inpatients receiving hemodialysis (86 of 623 inpatients), 3% for HIV‐infected inpatients (5 of 161 inpatients), and 3% for inpatients requiring cardiac surgery (6 of 199 inpatients). The highest geometric mean quantity of MRSA was for inpatients requiring cardiac surgery (11,500 CFU per swab). An association was found between HIV infection and colonization with the USA300 or USA500 strain of MRSA ( P<0.001). The Brazilian clone was found for the first time in the United States. Pulsed‐field gel electrophoresis patterns for 11 isolates were not compatible with known USA types or clones.

Conclusion.Nasal swab specimens positive for MRSA had a geometric mean quantity of 794 CFU per swab, with great diversity in the quantity of MRSA at this anatomic site. Outpatient populations at high risk for MRSA carriage were elderly residents of long‐term care facilities, HIV‐infected outpatients, and outpatients receiving hemodialysis.

gemao

美国感染控制与流行病学杂志2010年第6期
58专业保健人员金葡菌定植的流行病学特征
目的：为确定在健康机构中有过不同程度暴露于急诊病人和普遍特性菌株的医务人员中，无症状携带金黄色葡萄球菌和MARS的流行率。
方法： 20 08年在城市地区护理的大学医院中进行的单中心，横断面研究，涉及256名工作人员，分别来自ICU 、急诊室和住院前服务处。询问职业史和鼻腔金葡菌培养。使用SPA印迹法分离具有普遍特点的金葡菌，筛选mecA。MRSA菌株需要进一步界定。
结果：在256名HCP中分离到112株金葡菌(43.8%)，包括52名医务辅助人员中的30人(57.7%)，124名护士中的51人(41.1%)，28名文职工作人员中的11人(39.3%)，和53名医生中的20人(38.5%)。从17名(6.6%)HCP中分离到MRSA 菌株，包括1名医务辅助人员 (1.9%)，13名(10.5%)护士，1名(3.6%)文职共工作员，2名(3.8%)医生。在分离的金葡菌中，15.2%是MRSA。在急诊工作者中，MRSA的流行率是9.6% (12/125)，在ICU工作人员中是5.1% (4/79)，在急诊医疗服务人员中是1.9% (1/52).与医务辅助人员中分离的金葡菌中有最低的甲氧西林耐药流行(1 of 30  分离株[3.3%]),相比，护士有最高的流行率(13 of 51  分离株[25.4%])，对于甲氧西林耐药的可信度有9.92 (95% 可信区间, 1.32–435.86;P=0.02  )。在分析了15株MRSA，显示7例是USA100株，6例是USA300株，1例USA800 株 和1例EMRSA-15株。所有USA300株均来自急诊工作人群。
结论：在健康机构中工作人员金葡菌和MRSA定植的流行率超过原先报道的一般人群中的流行率。社区相关的MRSA占定植在HCP人群中总MRSA中的比例反应出在美国住院病人中USA 300 社区相关菌株的分布增加。

gemao

美国感染控制与流行病学杂志2010年第6期
60、病人MRSA鼻腔定植分子指纹分析的多中心研究
目的：为更好地理解MRSA在不同病人群体中定植或感染的流行率，采用定量分析鼻腔培养的MRSA，使用分子指纹技术描述菌株特点。
设计：多中心前瞻性研究
地点  11个不同的住院和门诊健康设施（机构）
参加者; 在主动监测项目中MRSA阳性的住院病人， 接受透析的住院和门诊病人；HIV感染的住院和门诊病人；需要心脏手术的病人，需要长期会理的老年病人。
方法：从2006年1月23日到2007年7月27日间获得的鼻腔拭子标本；对MRSA菌株进行定量，通过分子指纹法描述特点。
结果： 全部444个鼻腔拭子培养出MRSA（基因平均定量为每拭子794 CFU; 范围, 3–15,000,000 CFU/ 拭子)。在住在长期护理机构的老年病人中MRSA的流行率是20%(25 of 125住院病人)，HIV的门诊病人是16%(78 of 494 门诊病人)，血透门诊病人是15%(31 of 208 门诊病人)，住院血透病人中是14% (86 of 623 住院病人),HIV住院病人中是3%(5 of 161 住院病人)。需要心脏手术的住院病人中是3%(6 of 199 住院病人).在需要心脏手术的住院病人中MRSA的平均基因定量最高(11,500 CFU / 拭子).在HIV感染和定植MRSA  USA300或USA 500 菌株之间存在相关( P<0.001)。第一次在美国发现巴西克隆。11个菌株的PFGE模式与已知的美国类型不能匹配。
结论 鼻腔拭子MRSA阳性的标本中每个拭子基因平均定量794CFU，在此解剖位置的MRSA定量具有很大的多样性。高危MRSA携带的门诊病人是住在长期护理机构的老年病人，HIV感染的门诊病人和接受血透的门诊病人。

gemao

美国感染控制与流行病学杂志2010年第6期
59、金葡菌鼻腔定植与ICU病人继发感染
背景：金葡菌是ICU 病人感染的重要原因。MRSA的定植是随之而来金葡菌感染的风险因子。但是，MRSA定植的病人比MSSA定植或没有定植病人有更多的合并症，因此，根据这个基础可能就更容易感染。
目的： 为确定是否MRSA定制病人 住院和外科ICU，更可能出现金葡菌感染在ICU 中，与MSSA定植的病人，或没有金葡菌定植的病人相比，独立于易患病人的风险因子。
设计： 前瞻性队列研究
地点：一家1252张床的教学医院，其中有24张床位的SICU和19张床位的内科ICU。
病人： 从2002年12月至2007年8月，接受进入ICU的9523名病人全部进行鼻腔拭子采样，用于培养金葡菌。
方法：检查在ICU中超过48小时的病人发生ICU获得性金葡菌感染的情况，定义为在进入ICU后48小时出现的金葡菌感染。
结果： 在5161名病人中有1433人(27.8%)在住院时存在金葡菌定植，(674 [47.0%] 有MRSA ， 759 [53.0%] 有 MSSA)。在113名(2.19%)病人中出现ICU获得性金葡菌感染，其中75人(66.4%)是MRSA感染，ICU获得性金葡菌感染的风险因子包括住院时MRSA定植(调整风险比, 4.70 [95% 可信区间, 3.07–7.21])，和住院时MSSA的定植(调整风险比, 2.47 [95% 可信区间, 1.52–4.01])。
结论： 定植金葡菌的ICU病人有很高的风险在ICU中发展成金葡菌感染。即使调整病人-特异性风险因子之后，MRSA定植的病人与MSSA定植的病人相比更可能发展成金葡菌感染。

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回复 91# gemao
cross‐sectional study 横断面研究

gemao

回复 94# 潮水


以前是外科医生，对统计学的词汇不了解，还请多指教。

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美国感染控制与流行病学杂志2010年第6期
61、Universal Methicillin-Resistant Staphylococcus aureus (MRSA) Surveillance for Adults at Hospital Admission: An Economic Model and Analysis成人病人入院普查MRSA的成本效益分析
Background.Methicillin-resistant Staphylococcus aureus (MRSA) transmission and infections are a continuing problem in hospitals. Although some have recommended universal surveillance for MRSA at hospital admission to identify and to isolate MRSA-colonized patients, there is a need for formal economic studies to determine the cost-effectiveness of such a strategy.

Methods.We developed a stochastic computer simulation model to determine the potential economic impact of performing MRSA surveillance (ie, single culture of an anterior nares specimen) for all hospital admissions at different MRSA prevalences and basic reproductive rate thresholds from the societal and third party–payor perspectives. Patients with positive surveillance culture results were placed under isolation precautions to prevent transmission by way of respiratory droplets. MRSA-colonized patients who were not isolated could transmit MRSA to other hospital patients.

Results.The performance of universal MRSA surveillance was cost-effective (defined as an incremental cost-effectiveness ratio of less than $50,000 per quality-adjusted life-year) when the basic reproductive rate was 0.25 or greater and the prevalence was 1% or greater. In fact, surveillance was the dominant strategy when the basic reproductive rate was 1.5 or greater and the prevalence was 15% or greater, the basic reproductive rate was 2.0 or greater and the prevalence was 10% or greater, and the basic reproductive rate was 2.5 or greater and the prevalence was 5% or greater.

Conclusions.Universal MRSA surveillance of adults at hospital admission appears to be cost-effective at a wide range of prevalence and basic reproductive rate values. Individual hospitals and healthcare systems could compare their prevailing conditions (eg, the prevalence of MRSA colonization and MRSA transmission dynamics) with the benchmarks in our model to help determine their optimal local strategies.

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美国感染控制与流行病学杂志2010年第6期
62、Occurrence of Skin and Environmental Contamination with Methicillin-Resistant Staphylococcus aureus before Results of Polymerase Chain Reaction at Hospital Admission Become Available入院MRSA皮肤和环境污染PCR检测
Background.Active surveillance to detect patients colonized with methicillin-resistant Staphylococcus aureus (MRSA) is increasingly practiced in healthcare settings. However, inpatients may already become sources of transmission before appropriate precautions are implemented.

Objective.To examine the frequency of MRSA contamination of commonly touched skin and environmental surfaces before patient carriage status became known.

Methods.We conducted a 6-week prospective study of patients who were identified by use of polymerase chain reaction (PCR) at hospital admission as having nasal MRSA colonization. Skin and environmental contamination was assessed within hours of completion of PCR screening.

Results.There were 116 patients identified by PCR screening as having nasal MRSA colonization during the period from mid-April to May 2008, of whom 83 (72%) were enrolled in our study. Overall, MRSA was detected on the skin of 38 (51%) of 74 patients and in the environment of 37 (45%) of 83 patients. Of 83 environmental culture samples, 63 (76%) were obtained within 7 hours after PCR results became available, and 73 (88%) were obtained before wards were notified of PCR results. Of the 83 MRSA-colonized patients, 15 (18%) had contaminated their environment 25 hours after admission, and 29 (35%) had contaminated their environment 33 hours after admission. Thirty-two (39%) of the 83 patients had roommates, 13 (41%) of whom contaminated their environment. The median interval from admission to PCR result was 20 hours, and the median interval from PCR result to notification was 23 hours. An increased quantity of MRSA cultured from a nasal sample was significantly associated with contamination.

Conclusions.Before any contact precautions can be implemented, newly identified MRSA carriers frequently have contaminated their environment with MRSA and have contamination of commonly examined skin sites. In hospitals that perform active surveillance, strategies are needed to minimize delays in screening or to preemptively identify patients at high risk for disseminating MRSA.

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美国感染控制与流行病学杂志2010年第6期
63、Changes in the Molecular Epidemiological Characteristics of Methicillin-Resistant Staphylococcus aureus in a Neonatal Intensive Care Unit新生儿ICU的MRSA分子流行病学特征变化
Objective.To determine whether the molecular epidemiological characteristics of methicillin-resistant Staphylococcus aureus (MRSA) had changed in a level III neonatal intensive care unit (NICU).

Design.Retrospective review of medical records.

Setting.Level III NICU of a university-affiliated children’s hospital in New York, New York.

Patients.Case patients were neonates hospitalized in the NICU who were colonized or infected with MRSA.

Methods.Rates of colonization and infection with MRSA during the period from 2000 through 2008 were assessed. Staphylococcal chromosomal cassette (SCC) mecA analysis and genotyping for S. aureus encoding protein A (spa) were performed on representative MRSA isolates from each clonal pulsed-field gel electrophoresis pattern.

Results.Endemic MRSA infection and colonization occurred throughout the study period, which was punctuated by 4 epidemiologic investigations during outbreak periods. During the study period, 93 neonates were infected and 167 were colonized with MRSA. Surveillance cultures were performed for 1,336 neonates during outbreak investigations, and 115 (8.6%) neonates had MRSA-positive culture results. During 2001–2004, healthcare-associated MRSA clones, carrying SCC mec type II, predominated. From 2005 on, most MRSA clones were community-associated MRSA with SCC mec type IV, and in 2007, USA300 emerged as the principal clone.

Conclusions.Molecular analysis demonstrated a shift from healthcare-associated MRSA (2001–2004) to community-associated MRSA (2005–2008).

gemao

美国感染控制与流行病学杂志2010年第6期
61、Universal Methicillin-Resistant Staphylococcus aureus (MRSA) Surveillance for Adults at Hospital Admission: An Economic Model and Analysis
成人病人入院普查MRSA的成本效益分析
背景：医院中MRSA的传播和感染是一个持久的问题。尽管有人推荐在病人入院时进行普遍的MRSA监测来发现和隔离MRSA定植的病人，这需要有正式的经济学研究来确定达到这一目标的成本效益。
方法：我们建立随机计算机模拟模型来分析在病人入院时进行普遍性MRSA监测（即鼻前庭标本单次培养）在不同的MRSA流行率的潜在经济学影响，以及从社会和第三方判断基础繁殖率(basic reproductive rate 这么翻译对吗？）阈值。阳性监测培养结果的病人设立隔离预防措施，防止通过飞沫来传播。没有隔离的MRSA定植病人可能将MRSA传播给其他病人。
结果 普遍性MRSA监测的执行是有成本效益（定义为每 quality-adjusted life-year（此词没查到）不足$50,000增加成本效益比例）当基础繁殖率为0.25或更高时，流行率为1%或更高。事实上，当基础繁殖率是1.5或更高，流行率为15%或更高；基础繁殖率为2.0或更高时，流行率是10%或更高；当基础繁殖率是2.5或更高时，流行率为5%或更高。监测成为主要策略
结论 在有很大范围流行率和基础繁殖率值时，成年人入院时普遍性MRSA监测显示出具有成本效益。单独的医院和健康系统可以与我们模型的中基准比较他们的优势条件（如MRSA定植的流行率和MRSA传播动力学），帮助他们确定适当的当地策略。

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basic reproductive rate 基本繁殖率（基本增殖指数）：将有传染性的病例引入一个完全易感的人群中，在病例具有传染性期间，被病例直接感染的易感个体的平均数。

    质量调整寿命年(QALYs, Quality-adjusted life years) 一种调整的期望寿命，用于评价和比较健康干预。如果健康的生活了一年则记为1; 如果死亡则记为0; 如果是伤残则根据适当的标准记为0~1之间的数字。
　　如果经过诊断，认为一位患者可以以现在有疾病的状态生存10年。 假设这位患者可以选择完全健康但是生存的时间将会减少为8年，则该患者今后10年将被认为是8个质量调整寿命年(QALYs)。