手术前耐甲氧西林金黄色葡萄球菌筛查及其影响因素

Methicillin-resistant Staphylocoaus aureus screening before operation and its influencing factors

目的探讨外科手术患者术前耐甲氧西林金黄色葡萄球菌（MRSA）筛查阳性情况及其影响因素。方法对浙江省立同德医院外科择期手术患者进行鼻拭子、咽拭子和伤口分泌物的MRSA筛查，选用PCR进行检验。根据筛查结果，对可能影响因素进行单因素分析，随后对单因素有统计学意义的变量进行多元逐步Logistics回归分析。结果2016年4月至2018年1月共完成1755例手术患者筛查，伤I：3、鼻部、咽部MRSA筛查阳性率分别为12．68％（9／71）、4．67％（82／1755）和1．03％（18／1755），鼻部联合咽部的MRSA筛查阳性率5．36％（94／1755），鼻部、咽部联合伤口MRSA筛查阳性率即MRSA筛查总阳性率为5．81％（102／1755）。多因素分析显示，MRSA筛查阳性与院内转科（OR=11．567，95％CI：2．755~48．571），过去60个月曾接受过外科干预（OR=3．395，95％CI：2．138～5．391），存在伤口、溃疡或皮肤损伤（OR=2．931，95％CI：1．829～4．697），存在基础、终末期疾病或慢性健康合并症（OR=2．374，95％凹：1．467-3．849）和过去12个月曾使用过抗生素（OR=I．611，95％甜：1．047-2．481）有关。结论外科择期手术患者术前MRSA筛查阳性率较高，临床应结合相关危险因素早期评估，从而预防感染的发生。

Objective To explore the positive rate and identify the risk factors of methicillin-resistant Staphylocoaus aureus （MRSA） in surgical patients. Methods The MRSA screening for nose, pharynx and wound secretion were performed in patients with elective surgery in Tongde Hospital of Zhejiang Province. Polymerase chain reaction （PCR） was used for testing. According to the screening result, the single factor analysis and multiple stepwise logistic regression analysis were used to predict risk factors. Results A total of 1 755 patients were screened from April 2016 to January 2018. The positive rates of MRSA screening for wound, nose and pharynx samples were 12.68% （9/71）, 4.67% （82/1 755） and 1.03% （18/1 755） separately. The positive rate for nose combined with pharynx samples was 5.36% （94/1 755） and for nose, pharynx combined with wound samples which equaled to total positive rate was 5.81% （102/1 755）. Multivariate analysis revealed that positive detection rate of MRSA was associated with intra-hospital transfer （OR=I 1.567, 95%CI： 2.755-48.571 ） ; surgical interventions inthe last 60 months （0R=3.395, 95%C1： 2.138-5.391）; existing wounds, ulcers or skin lesions （OR=2.931 , 95%CI： 1.829-4.697） ; having basic, chronic or end-stage diseases （OR =2.374, 95%C1： 1.467-3.849） ; and antibiotics using in the past 12 months （0R=1.611,95%CI： 1.047-2.481）. Conclusions There is a high MRSA positive rate in surgical patients before surgery. Risk factors should be early evaluated, so as to prevent MRSA infection in clinical practice.