快速筛查MRSA的效果（翻译有奖）

潮水

The Effect of Rapid Screening for Methicillin‐Resistant Staphylococcus aureus (MRSA) on the Identification and Earlier Isolation of MRSA‐Positive Patients
Infect Control Hosp Epidemiol 2010;31:374–381
Objectives.(1) To determine whether rapid screening with polymerase chain reaction (PCR) assays leads to the earlier isolation of patients at risk for methicillin‐resistant Staphylococcus aureus (MRSA) colonization, (2) to assess compliance with routine MRSA screening protocols, (3) to confirm the diagnostic accuracy of the Xpert MRSA real‐time PCR assay (Cepheid) by comparison with culture, and (4) to compare turnaround times for PCR assay results with those for culture results.

Design.Before‐and‐after study conducted in a 700‐bed acute tertiary care referral hospital. Study periods were (1) a 5‐week period before PCR testing began, (2) a 10‐week period when the PCR assay was used, and (3) a 5‐week period after PCR testing was discontinued.

Results.Among 489 at‐risk patients, MRSA was isolated from 20 (33%) of 60 patients during period 1, 77 (22%) of 349 patients during period 2, and 18 (23%) of 80 patients during period 3. Twenty‐two (27%) of 82 at‐risk patients were not screened during period 1, compared with 40 (10%) of 389 at‐risk patients not screened during period 2 ( ). More MRSA‐positive patients were preemptively isolated during periods 1 and 3 compared with period 2 (34 [24%] of 140 vs 28 [8%] of 389;  ); however, more MRSA‐positive patients were isolated after notification of MRSA‐positive results during period 2 (47 [13%] of 349) compared with periods 1 and 3 (2 [1%] of 140;  ). The sensitivity, specificity, positive predictive value, and negative predictive value of the PCR assay were 95%, 97%, 82%, and 99%, respectively. The mean turnaround time from receipt of specimens in the laboratory to PCR assay result was 2.6 hours.

Conclusions.Rapid screening with the Xpert MRSA PCR assay facilitated compliance with screening policies and the earlier isolation of MRSA‐positive patients. Discrepant results confirm that PCR testing should be used as a screening tool rather than as a diagnostic tool.

ting2008

对不起版主，这个对我有点难度，实在是

wjllulu

目标：（1）探索是否可以使用聚合酶链反应（PCR）快速检测法筛选MRSA高风险携带者，从而进行早期隔离。　（2）评估遵守常规MRSA管理规定的情况，（３）通过与传统培养方法的比较，确定Xpert　MRSA实时PCR检测(Cepheid)诊断的准确性，（4）比较传统培养与PCR快速检测结果所用的时间。

设计：研究选在700床位的甲等急症治疗医院进行。实验分期：第一期间为PCR检测开始前5周期间；第二周期为用PCR检测的10周期间。第三周期为PCR检测结果后5周期间。

结果：本研究共489高危病人，第一期间中，60例患者中分离出20例（33％）；第二期间在349例患者中分离出77例（22％）；第三期间，在80例患者中分离出18例（23％）。在第一期间，82例高危患者中有 22例（27％）未进行筛查，而第二期间389高危患者中有40（10％）没有进行筛选。第一和第三阶段MRSA阳性者（未接到通知之前）被先隔离起来的人比在第二阶段（这样做的人）多，分别为140人中34人（24％）和389人中28人（[8％）。然而，在第二期间更多的MRSA患者（349人中的47人（13％）是在被通知阳性结果后才隔离。而第一期间和第三期间中140人只有2人（1％）（是这个情况）。本次快速PCR检测测试的敏感性，特异性，阳性预测值，阴性预测值分别为95％，97％，82％和99％。在实验室PCR检测，从收到标本到出结果的平均（周转）时间为2.6小时。

结论：快速Xpert MRSA的PCR筛选检测有利于遵守MRSA筛检制度和早期隔离阳性的患者。对于有差异的结果证实，PCR检测应作为一个筛选工具，而不是作为一种诊断工具。

腊梅

敬佩wjllulu 老师，咱们外语太差。