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首页> 外文期刊>Medicine. >Risk Factors of Methicillin-Resistant Staphylococcus aureus Infection and Correlation With Nasal Colonization Based on Molecular Genotyping in Medical Intensive Care Units: A Prospective Observational Study
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Risk Factors of Methicillin-Resistant Staphylococcus aureus Infection and Correlation With Nasal Colonization Based on Molecular Genotyping in Medical Intensive Care Units: A Prospective Observational Study

机译：基于分子基因分型的医疗重症监护病房耐甲氧西林金黄色葡萄球菌感染的危险因素及其与鼻部定植的相关性：一项前瞻性观察研究

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Methicillin-resistant Staphylococcus aureus (MRSA) is a common and important cause of colonization and infection in medical intensive care units (ICU). The aim of this study was to assess association factors between MRSA nasal colonization and subsequent infections in medical ICU patients by clinical investigation and molecular genotyping. A prospective cohort observational analysis of consecutive patients admitted to medical ICUs between November 2008 and May 2010 at a tertiary teaching hospital were included. To detect MRSA colonization, the specimens from the nares were obtained within 3 days of admission to the ICU and again 1 week following admission to the ICU. Genetic relatedness for colonized and clinical isolates from each study patient with MRSA infection were analyzed and compared. A total of 1266 patients were enrolled after excluding 195 patients with already present MRSA infections. Subsequent MRSA infection rates were higher in patients with nasal colonization than in those without (39.1% versus 14.7%, respectively). Multivariate Poisson regression analysis demonstrated that nasal MRSA colonization (relative risk [RR]: 2.50; 95% confidence interval [CI]: 1.90–3.27; P < 0.001) was independent predictors for subsequent MRSA infections. History of tracheostomy, however, was a protective predictor in all patients (RR: 0.38; 95% CI: 0.18–0.79; P = 0.010) and in patients with MRSA nasal colonization (RR: 0.22; 95% CI: 0.55–0.91; P = 0.037). Molecular genetics studies revealed that most MRSA isolates were healthcare-associated clones and that nasal and clinical isolates exhibited up to 75% shared identity. Methicillin-resistant S. aureus nasal colonization was significantly associated with subsequent MRSA infection among medical ICU patients. Previous MRSA infection was associated with subsequent MRSA infections, and history of tracheostomy associated with reducing this risk. Most MRSA isolates were healthcare-associated strains that were significantly correlated between nasal and clinical isolates.
机译：耐甲氧西林金黄色葡萄球菌（MRSA）是医疗重症监护病房（ICU）定植和感染的常见且重要原因。这项研究的目的是通过临床调查和分子基因分型来评估医学ICU患者的MRSA鼻部定植与随后感染之间的关联因素。包括前瞻性队列观察分析在2008年11月至2010年5月期间在三级教学医院接受医疗ICU的连续患者。为了检测MRSA的定植，从鼻孔收集的标本在入ICU的3天内和入ICU的1周内再次获得。分析并比较了每例MRSA感染患者的定殖和临床分离株的遗传相关性。排除195例已经存在MRSA感染的患者后，总共招募了1266例患者。鼻定植患者随后的MRSA感染率高于无鼻定植患者（分别为39.1％和14.7％）。多元Poisson回归分析表明，鼻部MRSA定植（相对风险[RR]：2.50; 95％置信区间[CI]：1.90–3.27; P <0.001）是随后发生MRSA感染的独立预测因子。然而，气管切开史是所有患者的保护性预测指标（RR：0.38; 95％CI：0.18–0.79; P = 0.010）和MRSA鼻腔定植患者（RR：0.22; 95％CI：0.55-0.91; MRSA）。 P = 0.037）。分子遗传学研究表明，大多数MRSA分离株是与医疗保健相关的克隆，而鼻和临床分离株显示出高达75％的共享身份。在医疗ICU患者中，耐甲氧西林的金黄色葡萄球菌鼻定植与随后的MRSA感染显着相关。先前的MRSA感染与随后的MRSA感染相关，而气管切开术的历史与降低这种风险相关。大多数MRSA分离株是与医疗相关的菌株，在鼻和临床分离株之间具有显着相关性。

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