医护人员：MRSA的来源、载体或受害者？

David

The Lancet Infecious Diseases
Volume 8, Issue 5, May 2008, Pages 289-301

Review
Health-care workers: source, vector, or victim of MRSA?
医护人员：MRSA的来源、载体或受害者？
Werner C Albrich MDa, b and Dr Stephan Harbarth MDc, ,

aRespiratory and Meningeal Pathogens Research Unit, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa

bInstitute for Infectious Diseases, University Hospital Bern, Bern, Switzerland

cInfection Control Program, Geneva University Hospitals, Geneva, Switzerland


Available online 7 May 2008.

Summary
There is ongoing controversy about the role of health-care workers in transmission of meticillin-resistant Staphylococcus aureus (MRSA). We did a search of the literature from January, 1980, to March, 2006, to determine the likelihood of MRSA colonisation and infection in health-care workers and to assess their role in MRSA transmission. In 127 investigations, the average MRSA carriage rate among 33 318 screened health-care workers was 4·6%; 5·1% had clinical infections. Risk factors included chronic skin diseases, poor hygiene practices, and having worked in countries with endemic MRSA. Both transiently and persistently colonised health-care workers were responsible for several MRSA clusters. Transmission from personnel to patients was likely in 63 (93%) of 68 studies that undertook genotyping. MRSA eradication was achieved in 449 (88%) of 510 health-care workers. Subclinical infections and colonisation of extranasal sites were associated with persistent carriage. We discuss advantages and disadvantages of screening and eradication policies for MRSA control and give recommendations for the management of colonised health-care workers in different settings.