ICU中MRSA屏障预防和主动筛查的成本效益分析

蓝鱼o_0

Topical antimicrobials in combination with admission screening
and barrier precautions to control endemic methicillin-resistant
Staphylococcus aureus in an Intensive Care Unit
Ian M. Gould a,∗, Fiona M. MacKenzie a, Graeme MacLennanb,
Diane Pacitti c, Emma J. Watson a, David W. Noble d
a Medical Microbiology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZN, UK
b Health Services Research Unit, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK
c Infection Control, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZN, UK
d Intensive Care Unit, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZN, UK

We aimed to establish whether screening for methicillin-resistant Staphylococcus aureus(MRSA)and body decontamination upon admission
to an Intensive Care Unit (ICU), in combination with barrier precautions, reduced rates of MRSA infection acquired on the unit. This was
an interrupted time series study employing segmented regression analysis of data collected for all patients admitted to a 16-bed adult ICU
over 48 months. Before the intervention (24 months; 1232 patients (44% female)), MRSA was sought from clinical cultures only and positive
patients were barrier nursed in isolation. During the intervention (24 months; 1421 patients (54% female)), all ICU patients were screened for
MRSA on admission and were barrier nursed in single rooms when established as MRSA-positive; all were given topical nasal anti-MRSA
preparations and daily bed baths with 4% chlorhexidine throughout their stay. Changes in the proportion of patients colonised or infected
with MRSA in the ICU were assessed. Before the intervention, 193 new MRSA cases (16%) were identified from 1232 ICU admissions;
during the intervention, this was reduced to 92 cases (6%) of 1421 admissions. By time series regression analysis, the proportion of patients
with MRSA decreased by 11.38% from ca. 15% to ca. 5% (ca. three-fold reduction) (95% confidence interval 3.5–19.3%; P = 0.005). Thus,
treatment of 11 patients prevented 1 clinical case of MRSA. Mean length of stay decreased significantly (P < 0.001). Although MRSA and
methicillin-susceptible S. aureus bacteraemia rates dropped, the changes detected were not statistically significant. The proportion of patients
with coagulase-negative staphylococcal bacteraemia decreased significantly (P < 0.001) and the trend changed from increasing to decreasing
(P < 0.001), as did the trend in glycopeptide use (P = 0.014). An inexpensive and easy to implement intervention to control MRSA in the ICU
was highly successful without compromising antimicrobial susceptibility.

四季如歌

全是英语啊，看不懂，有没有中文版的啊

HOPE-H

先载了，慢慢阅读，有可以学习英语，一举两得！