Risk Factors for Methicillin-Resistant Staphylococcus Aureus in Two Regional Hospitals

抗藥性金黃色葡萄球菌感染之危險因子探討

沈萬豐(Wang-Feng Shen) ； 梁雅畫(Ya-Hua Liang) ； 李銘宗(Ming-Tsung Lee) ； 凌美貝(Mei-Pei Ling) ； 郭依明(Yi-Ming Kuo) ； 楊玉英(Yu-Ying Yang)

《童綜合醫學雜誌》 11卷2期 (2017/12) Pp. 85-94

摘要

Background: Drug resistance has become a critical issue in public health. Methicillin-resistant Staphylococcus aureus (MRSA), in particular, is one of the most significant infectious pathogens in hospitals. Healthcare staff can sometimes become carriers of MRSA, which can spread to and infect patients. MRSA is difficult to control if a hospital outbreak, or even a cluster outbreak, occurs. Methods: This study used a retrospective chart review to collect a total of 473 cases, 228 MRSA and 245 methicillin-sensitive Staphylococcus aureus (MSSA) cases, from two regional hospitals in central Taiwan during 2012-2013. The patients' demographic data and information on potential risk factors for MRSA/MSSA were collected and compared to discriminate the factors associated with the highest risk. Results: After controlling for other factors, the results showed that significant risk factors for MRSA were a hospital stay of more than 30 days (OR 2.56, 95% CI 1.31-5.01, diabetes (OR 1.69, 95% CI 1.00-2.83), pneumonia during the previous year (OR 3.56, 95% CI 1.24-9.65), surgery during the previous year (OR 4.68, 95% CI 2.11-10.34), and catheterization with one tube (OR 2.19, 95% CI 1.19-4.03) or two tubes (OR 3.94, 95% CI 1.64-9.51). In addition, plural specimens (OR 6.41, 95% CI 1.30-31.57) and cultures taking more than 3 days (OR 2.41, 95% CI 1.34-4.34) were associated with MRSA. Conclusion: Patients at high risk of MRSA should be detected as early as possible, and MRSA awareness education for healthcare staff should be enhanced in order to reduce the spread of MRSA infection in hospitals and the incidence of cluster outbreaks.

關鍵字

Methicillin-resistant Staphylococcus aureus (MRSA) ； methicillin-sensitive Staphylococcus aureus (MSSA) ； risk factor

並列摘要

背景：抗藥性是公衛重要議題，抗藥性金黃色葡萄球菌（MRSA）感染是院內感染重要因素。醫護人員會成為MRSA帶原者且傳染給病患。如院內大流行或群聚感染則難以控制。方法：本研究採病例回溯研究，收集473名病患資料，其中228位MRSA，245位非抗藥性金黃色葡萄球菌（MSSA）感染病患，2012至2013年兩家區域醫院之病歷資料，包括人口學資料及臨床潛在危險因子。比較MRSA與MSSA之危險因子，作為預防方法依據。結果：多變項分析顯示MRSA之危險因子：住院超過30天（OR 2.56, 95% CI 1.31-5.01）、糖尿病（OR 1.69, 95% CI 1.00-2.83）、一年內肺炎（OR 3.56, 95% CI 1.24-9.65）、一年內手術（OR 4.68, 95% CI 2.11-10.34）、一條管路（OR 2.19, 95% CI 1.19-4.03）及兩條管路（OR 3.94, 95% CI 1.64-9.51）、腹膜檢體（OR 6.41, 95% CI 1.30-31.57）及培養超過3天（OR 2.41, 95% CI 1.34-4.34）。結論：MRSA高危險群須儘早檢測，加強醫護感控教育以降低傳播。

並列關鍵字

抗藥性金黃色葡萄球菌 ； 非抗藥性金黃色葡萄球菌 ； 危險因子