推荐阅读：有没有比菌血症监测更好的监督MRSA防控的方法？

David

防控MRSA的文章居然上到PLoS这样级别的杂志，十分罕见啊。PLoS的杂志影响因子不亚于Nature和Science。而且都喜欢登一些非主流但超级前沿的研究，基本上就是和Nature打擂台的。当年PLoS系列杂志出来的原因就是为了防止natue和science垄断高分文章出版的市场而由一些诺贝尔奖得主创办的全免费在线杂志。虽然只有不到10年的历史，但影响因子最近几年是相当恐怖~~:victory: 补点历史课，呵呵~

PLoS ONE. 2008 Jun 11;3(6):e2378.
Are there better methods of monitoring MRSA control than bacteraemia surveillance? An observational database study.
有没有比菌血症监测更好的监督MRSA防控的方法？
Walker S, Peto TE, O'Connor L, Crook DW, Wyllie D.
Oxford Radcliffe Hospitals NHS Trust, John Radcliffe Hospital, Oxford, United Kingdom.

BACKGROUND: Despite a substantial burden of non-bacteraemic methicillin resistant Staphylococcus aureus (MRSA) disease, most MRSA surveillance schemes are based on bacteraemias. Using bacteraemia as an outcome, trends at hospital level are difficult to discern, due to random variation. We investigated rates of nosocomial bacteraemic and non-bacteraemic MRSA infection as surveillance outcomes. METHODS AND FINDINGS: We used microbiology and patient administration system data from an Oxford hospital to estimate monthly rates of first nosocomial MRSA bacteraemia, and nosocomial MRSA isolation from blood/respiratory/sterile site specimens ("sterile sites") or all clinical samples (screens excluded) in all patients admitted from the community for at least 2 days between April 1998 and June 2006. During this period there were 441 nosocomial MRSA bacteraemias, 1464 MRSA isolations from sterile sites, and 3450 isolations from clinical specimens (8% blood, 15% sterile site, 10% respiratory, 59% surface swabs, 8% urine) in over 2.6 million patient-days. The ratio of bacteraemias to sterile site and all clinical isolations was similar over this period (around 3 and 8-fold lower respectively), during which rates of nosocomial MRSA bacteraemia increased by 27% per year to July 2003 before decreasing by 18% per year thereafter (heterogeneity p<0.001). Trends in sterile site and all clinical isolations were similar. Notably, a change in rate of all clinical MRSA isolations in December 2002 could first be detected with conventional statistical significance by August 2003 (p = 0.03). In contrast, when monitoring MRSA bacteraemia, identification of probable changes in trend took longer, first achieving p<0.05 in July 2004. CONCLUSIONS: MRSA isolation from all sites of suspected infection, including bacteraemic and non-bacteraemic isolation, is a potential new surveillance method for MRSA control. It occurs about 8 times more frequently than bacteraemia, allowing robust statistical determination of changing rates over substantially shorter times or smaller areas than using bacteraemia as an outcome.