A multicenter study of targeted surveillance at Intensive Care Unit acquired MRSA infection in Tianjin district

Abstract

Objective To study the incidence and risk factors of infection caused by methicillin-resistant staphylococcus aureus(MRSA)with a targeted surveillance at intensive care unit(ICU)acquired MRSA infection in Tianjin area. Methods A prospective multi-center observational analysis of consecutive patients admitted to 15 adult ICUs from March 1, 2012 through March 31, 2014 was carried out. The ICUs were divided into four groups according to the type of the ICU. All of the patients were cared for with routine MRSA surveillance. A number of risk markers and prognostic factors were recorded. The risk factors contributing to ICU acquired MRSA were evaluated using a logistic regression model. Comparison of survival between groups was analyzed with Kaplan-Meier method. Results A total of 1 787 patients were enrolled, and 144 cases of them were MRSA infections. The patients with MRSA infection were significantly older than those with non-MRSA infection (P=0.043), length of ICU stay, length of antimicrobial therapy, the history of repeated administration of antibiotics in recent days, history of operation in the past five years, history of MRSA infection or colonization, frequent application of and the overall length of time for mechanical ventilation and central venous catheter and catheter-associated infection were significantly higher than those with non-MRSA infection. The survival rate of patients with non-MRSA infection were higher than those with MRSA infection (χ2=9.23, P=0.004). The rate of MRSA infection and MRSA colonization in 2013 were significantly lower than that in 2012, because the rate of hand hygiene rule execution and bacterial clearance rate were significantly higher in 2013. Multivariate Logistic regression analysis demonstrated that advanced age (OR=1.05, 95%CI: 1.009-1.086), length of ICU stay (OR=1.05, 95%CI: 1.01-1.08), history of MRSA infection or colonization(OR=1.33, 95%CI: 1.82-3.27), glucocorticoid therapy(OR=2.85, 95%CI: 1.18-6.91), antacid medicine(OR=4.92, 95%CI: 1.18-20.58), history of recent or repeated application of antibiotics(OR=3.26, 95%CI: 1.06-4.59)catheter-associated infections (OR=2.22, 95%CI: 1.08-4.59) were associated with ICU acquired MRSA infections. Conclusions Performing the rule of hand hygiene strictly as well as strengthening prevention and control of MRSA infections can effectively reduce the incidence of ICU acquired MRSA infections. The advanced age, length of ICU stay, history of MRSA infection or colonization, glucocorticoid therapy, antacids medicine, history of recent or repeated application of antibiotics, catheter-associated infections were independent risk factors of ICU acquired MRSA infections. Key words: Intensive care unit; Methicillin resistant staphylococcus aureus(MRSA); Risk factor; Targeted surveillance