Epidemiological Study on Nosocomial Methicillin Resistant Staphylococcus Aureus (MRSA) in Putuo District, Shanghai
|Keywords||Methicillin-resistant Staphylococcus aureus Hospital infection rates Risk factors Case-control study Etiology Bacterial Resistance|
Methicillin-resistant Staphylococcus aureus (methicillin-resistant staphylicoccus aureus, MRSA) is currently the most important hospital infection resistant bacteria. Which accounts for the proportion of clinical isolates of Staphylococcus aureus has been the first 5% of development can be as high as 89.47% detection rate in some hospitals. In recent years, the prevalence of MRSA is characterized by infection rate, mortality is rising. Coverage will MRSA caused by infection with the hepatitis B, AIDS known as the three major infectious diseases of the world today, has been caused by the global medical community's attention. The purpose of this project is to Putuo District Hospital nosocomial MRSA infection Survey, combined case-control study to explore the risk factors for MRSA clinical MRSA infections, provide the basis for further effective control. The study is divided into the following two parts: the first part of hospital MRSA infection status quo research purposes to investigate the Putuo District Hospital of nosocomial MRSA infection rates of infection, clinical characteristics, antibiotic resistance and demographic distribution, further effective control for clinical MRSA infections basis. For January 1, 2008 - December 31, Putuo District, four general hospital all patients discharged from medical history, cross-sectional survey of its Chinese medicine hospital in nosocomial MRSA infections, described the analysis of objects MRSA infection MRSA cases the clinical features of drug resistance and demographic distribution. Results in four hospitals in 2008, 75,871 cases of discharged cases, 3362 patients with hospital infection, hospital infection rate was 5.15%. 248 of Staphylococcus aureus infection, including MRSA infections, 203, the detection rate of 81.85%, and the rest of methicillin-sensitive Staphylococcus aureus (Methicillin-sensitive Staphylococcus aureus, MSSA) 45 (18.15%). 203 cases of hospital infection MRSA patients, 119 cases of male and female 84 cases, the median age of 76 years, mainly distributed in the ICU (32.5%), surgery (19.7%), hematology (7.4%). The average nosocomial MRSA infection rate in 2008 was 2.68 ‰, the highest infection rate in the neurology intensive care unit (NICU) is 29.5 per 1,000, followed by a comprehensive ICU (22.3 ‰) and coronary intensive care unit (CCU) 14.7 ‰. MRSA infection rates higher than the average hospital's department there neurosurgery (7.7 ‰), Hematology (4.7 ‰) and Respiratory Medicine (3.3 ‰). Month rate of infection in 2008 survey shows a relatively high infection rate in January (4.98 ‰) and February (4.86 ‰), and the formation of a peak, the infection rate of 3.24 per thousand in August, the formation of a small peak. 101 cases of lung infections in patients with hospital infection MRSA, accounting for 49.8%, 39 cases (19.2%) followed by wound infections, sepsis, and 26 patients (12.8%). Days of hospitalization before infection for up to 80 days, a minimum of four days, an average of 21.45d ± 16.72d. The t-test showed that the hospital days prior to the infection of the middle-aged group was 17.27 ± 14.51 days, shorter than the older group 23.28 ± 17.33 days, days of hospitalization in the two groups before infection significant difference (t = 2.386, P = 0.018). 94.09% of patients in the use of antimicrobial drugs before infection, 87 cases using three or more antibiotics, accounting for 42.86%. Hospital MRSA infection in patients with a poor prognosis, the fatality rate as high as 27.59%. Prognosis of the young group and the elderly group (x ~ 2 = 10.073, P = 0.006), healed or death in the young group accounted for 32.2% and accounted for 56.0%, while in the older group, the prognosis of the elderly group than in youth group. Determination of the sensitivity of the 203 MRSA 13 antimicrobial drugs, sensitivity gt; 70% of the vancomycin (100%), of Linezolid (91.6%) and rifampicin (87.2%); resistance rate gt ; 70% to oxacillin (100%), penicillin (100%), lactamase (100%), erythromycin (95.6%), Shu He Xilin (91.6%), levofloxacin gatifloxacin (83.7 %), gentamicin (79.8%) and tetracycline (74.9%). Further analysis of clinical distribution characteristics visible Hospital MRSA infections: In all 203 cases of MRSA cases, 83.7% received invasive procedures, 32.5% of ICU admission, 18.2% after admission hormones underlying disease distribution as follows: diabetes blood sugar control (46.3%), hypertension (42.9%), coronary heart disease (39.9%), stroke (34.5%), malignancy (32.5%), and liver and kidney failure (13.3%). Conclusion 2008 Putuo District Hospital Staphylococcus aureus infection in MRSA detection rate of 81.85%, slightly higher than the level of 80.3% in the detection rate of the general hospital in Shanghai. Nosocomial MRSA infection rate was 2.68 per 1,000 ICU infection rates highest, should strengthen the prevention and control of MRSA in ICU. Hospital patients with MRSA infections (≧ 65-year-old male, older), the main ICU admission and surgery, lung infections and wound infections. The median age of 76 years. Days of hospitalization before infection in 203 patients for up to 80 days, a minimum of four days, an average of 21.45 ± 16.72 days. Patients with MRSA infection, the basic use of broad-spectrum antibiotics, and is associated with of ≧ 3 kinds of antibiotics accounted for 42.86%. Hospital MRSA infections and poor prognosis, the fatality rate was 27.59%. The second part of hospital MRSA infections risk factors for research purposes to explore the risk factors of hospital MRSA infections, and to provide a scientific basis for taking effective measures to reduce hospital MRSA infection rates. The method of this study into a 1:1 case-control study design. 108 pairs according to the demand of the sample size, the subjects included in the qualified group of cases from the Putuo District, two more than in 2008 general hospital nosocomial MRSA infection; control group from the hospital non-nosocomial infections in the crowd, the gender composition of the case and control groups vary lt; 5%, Hospital and Ward differences in lt; 5%, close to the date of admission of cases and controls. Using the unified design of the questionnaire to collect information through the inspection history of cases and controls information. The investigation includes the basic situation of the patient's underlying disease situation, the number of days of hospitalization, type and time of use of broad-spectrum antibiotics; immunocompromised; surgery and invasive procedures, and treatment; merge multiple infections. Data were analyzed using x ~ 2 test and non-conditional logistic regression models and statistical methods. Results collecting cases and controls were 108 patients, univariate analysis showed that the following factors may be associated with hospital MRSA infection related to old age (≧ 65 years old, P = 0.013), duration of hospitalization (P lt; 0.0001), the number of underlying diseases (P lt; 0.001) as well as the underlying disease in poor glycemic control of diabetes (P lt; 0.001) and stroke (P = 0.005), invasive operations such as surgery (P lt; 0.001), catheterization (P lt; 0.001), intubation (P lt; 0.001), vascular catheter (P = 0.027), drainage (P = 0.003), gastric tube (P = 0.009), endoscopic (P = 0.016), ventilator (P lt; 0.001), and invasive procedures the number of items (P lt; 0.001), co-infection of other multi-resistant bacteria (P lt; 0.001), the use of broad-spectrum antibiotics (P lt; 0.001), types of antibiotics (P = 0.004) and the use of time (P lt ; 0.001). Multivariate analysis showed that MRSA infection risk and hospital-related risk factors include hospitalization time (P lt; 0.001), invasive procedures the number of items (P = 0.001), antibiotic use types (P = 0.001), and antibiotic use ( P = 0.001). Conclusion long hospital stay, more invasive operation the number of items, long-term use of broad-spectrum antibiotics and antibiotic type many possible risk factors for hospital MRSA infections.