The Role of Healthcare Workers with Methicillin-Resistant Staphylococcus aureus Carriage and their Association with Clinical Isolates from Post-neurosurgical Wound Infections

醫護人員金黃色葡萄球菌帶原調查及其和神經外科術後成傷口感染的關連性

李育霖(Yu-Lin Lee) ； 劉元孟(Yuag-Meng Liu) ； 張志演(Chih-Yen Chang) ； 張淑琪(Shu-Chi Chang) ； 林麗珍(Li-Chen Lin) ； 邱怡貞(Yi-Chen Chiu) ； 葉慧敏(Hui-Min Yeh) ； 鄭均洹(Chun-Yuan Cheng) ； 劉尊榮(Chun-Eng Liu)

《內科學誌》 24卷2期 (2013/04) Pp. 123-130

https://doi.org/10.6314/JIMT.2013.24(2).06

摘要

Methicillin-resistant Staphylococcus aureus (MRSA) is the leading pathogen of postoperative wound infections. A series of cases of post-neurosurgical wound infection with MRSA were detected in 1 and half months. A prospective survey of carriage in health-care workers (HCWs) and environmental contamination was conducted. The rate of MRSA nasal carriage in HCWs was higher than the rate of environmental contamination (11.3% versus 0.6%, p ＜ 0.05). HCWs who were directly in contact with the infected patients had higher carriage rates than others (31.0% versus 3.8%, p ＜ 0.05), while doctors had the highest carriage rates among all professionals (21.7% versus 8.3%, p ＜ 0.05). Clinical isolates from post-neurosurgical wounds belonged to 3 different clusters; however, all had genotypes identical to those obtained from HCWs with staphylococcal carriage, including neurosurgeons, resident doctors, nurses, anesthesiologists, and anesthesia assistants. HCWs have an important role in the intra-hospital transmission of MRSA. This study highlighted the importance of hand hygiene in preventing contact transmission. Importantly, decolonization of MRSA carriage can be considered as a method of adjuvant infection control for interrupting an ongoing MRSA spread.

並列摘要

Methicillin-resistant Staphylococcus aureus (MRSA) is the leading pathogen of postoperative wound infections. A series of cases of post-neurosurgical wound infection with MRSA were detected in 1 and half months. A prospective survey of carriage in health-care workers (HCWs) and environmental contamination was conducted. The rate of MRSA nasal carriage in HCWs was higher than the rate of environmental contamination (11.3% versus 0.6%, p ＜ 0.05). HCWs who were directly in contact with the infected patients had higher carriage rates than others (31.0% versus 3.8%, p ＜ 0.05), while doctors had the highest carriage rates among all professionals (21.7% versus 8.3%, p ＜ 0.05). Clinical isolates from post-neurosurgical wounds belonged to 3 different clusters; however, all had genotypes identical to those obtained from HCWs with staphylococcal carriage, including neurosurgeons, resident doctors, nurses, anesthesiologists, and anesthesia assistants. HCWs have an important role in the intra-hospital transmission of MRSA. This study highlighted the importance of hand hygiene in preventing contact transmission. Importantly, decolonization of MRSA carriage can be considered as a method of adjuvant infection control for interrupting an ongoing MRSA spread.

並列關鍵字

Methicillin-resistant Staphylococcus aureus ； Nasal carriage ； Postoperative surgical wound infection ； Mupirocin decolonization