임상 ; 적극적 감염 관리를 통한 신생아 중환자실내의 MRSA 근절 효과: 격리 프로그램 및 Chlorhexidine 사용

김형진 ( Hyoung Jin Kim ),강성진 ( Sung Jin Kang ),박현경 ( Hyun Kyung Park ),김창렬 ( Chang Ryul Kim ),최태열 ( Tae Yeal Choi ),오성희 ( Sung Hee Oh ) 대한주산의학회 2010 Perinatology Vol.21 No.3

목적: 신생아중환자실에서 MRSA 집락화 및 균혈증을 줄이기 위한 노력으로 격리 프로그램과 2% CHG 사용 효과를 알아보고자 하였다. 방법: 2007년 6월부터 2009년 10월까지 한양대학교 서울병원 신생아중환자실에 입원한 414명의 환아를 대상으로 의무 기록을 후향적으로 조사하였다. 2007년 6월부터 2007년 10월까지를 1기, 2007년 11월부터 2008년 10월까지 격리 프로그램을 시행한 기간을 2기, 2008년 11월부터 2009년 10월까지 격리 프로그램과 더불어 피부소독제를 2% CHG으로 바꾸어 사용한 기간을 3기로 하였다. 전 기간 내내 MRSA 감시 배양(MRSA surveillance culture)을 시행하였다. 결과: MRSA 보균 및 감염의 위험인자로 알려진 출생 체중, 조산아, 입원 기간, 중심혈관 카테터 삽입 기간 등에서 3군간 유의한 차이를 보이는 요인이 없었으나, 격리 프로그램 및 2% CHG 사용에 따라 MRSA 집락화 및 균혈증 발생률이 통계학적으로 의미 있게 감소하였다. MRSA 집락화 및 균혈증의 위험 인자 조사에서는 입원기간, 중심혈관 삽입 여부 및 기간, 신생아 호흡 곤란 증후군 진단받은 경우, 기관지폐 형성이상 진단받은 경우에서 위험성이 더 높은 것으로 나타났고 격리 프로그램과 CHG 사용을 시행한 경우 위험성이 감소하는 것으로 나타났다. 결론: 신생아 중환자실에서 MRSA 보균 및 감염률을 낮추기 위해서는 철저한 손 씻기와 적극적인 MRSA 배양검사를 하면서, 적극적인 격리 관리와 피부 소독제로 CHG를 사용하는 것을 고려해 보아야 하며, 중심혈관 삽입기간을 최소화하는 노력도 해야 한다. Purpose: The increasing incidence and mortality of Methicillin-resistant Staphylococcus aureus (MRSA) colonization or blood-stream infection is an important problem in neonatal intensive care unit (NICU). The aims of this study are to evaluate the effective eradication of MRSA through the aggressive isolation program with or without the use of 2% chlorhexidine-gluconate (CHG) and to investigate significant risk factors of MRSA colonization in NICU. Methods: This study is a retrospective collected data among 414 neonates admitted to a NICU from June 1, 2007, through October 31, 2009. We divided the groups into 3 periods according to isolation program or the use of 2% CHG. Results: The aggressive isolation program decreased the incidence of MRSA colonization and the additional use of 2% CHG has reduced much more the incidence of MRSA colonization and bacteremia. Days of hospitalization, use of central line, days of using central line, presence of respiratory distress syndrome (RDS) or bronchopulmonary dysplasia (BPD), isolation program, and isolation program + use of CHG were significant factors associated with MRSA colonization or bacteremia in univariate logistic regression analysis. Days of using central line and isolation program + use of CHG were significant after in multivariate logistic regression analysis. Conclusion: Hand hygiene, active MRSA surveillance culture, isolation, contact isolation, nursing/doctor cohorts and the use of 2% CHG as skin sterilizer were effective in eradicating to MRSA. The effort of shortening the days of using central line is also necessary.

Methicillin-Resistant Staphylococcus aureus 감염에 있어서의 국내에서 제조된 반코마이신의 임상적 효과와 안전성에 관한 연구

김태형,최상호,이미숙,김남중,김양수,류지소,우준희,염윤기 대한화학요법학회 2002 대한화학요법학회지 Vol.20 No.4

배경 : 1980년대에 methicillin-resistant Staphylococcus aureus (MRSA)가 출현한 이래 반코마이신은 MRSA 감염증에 있어 선택적 약물로 널리 쓰여 왔다. 반코마이신과 관련된 부작용으로 알려져 있는 것으로는 red-man syndrome, 신 독성, 이 독성 등이 있다. 저자들은 MRSA감염증의 치료에 있어 국내에서 제조된 반코마이신의 임상적 효능과 안전성을 검증하고자 본 연구를 시행하였다. 방법 : 1999년 4월부터 2001년 9월까지 MRSA 감염증이 증명되거나 의심되어 반코마이신을 사용한 79명의 환자를 전향적으로 추적하여 반코마이신의 효능과 부작용을 평가하였다. 결과 : 총 42명의 환자가 MRSA 감염증으로 확진되어 평가 가능하였다. 폐렴(14/42 ; 33.3%)이 가장 흔한 MRSA 감염증이었으며 그 외의 원인으로는 피부와 연조직 감염(9/42: 11.9%), 원발병소미상의 패혈증(5/42: 11.9%), 중심정맥도관감염증(5/42; 11.9%)의 순이었다. Favorable clinical response (cure or improved)는 31명(75.6%)의 환자에게서 나타났고, favorable bacteriological response (eradicated or presumed eradicated)는 28명(68.3%)에서 나타났다. MRSA 감염증과 관련된 사망률은 14.3%였다. 반코마이신과 관련된 부작용으로는 피부발진, red-man syndrome, 신독성, 백혈구감소증이 각각 2명이었고 혈소판 감소증이 1명에서 발생하였다. 결론 : 제한적인 수의 환자를 대상으로 한 결과이기는 하나 국내에서 제조된 반코마이신은 다양한 종류의 MRSA 감염증에 있어 비교적 효과적이고 안전한 치료제로 평가되며 보다 대규모의 비교연구가 필요할 것이다. Background : Since the emergence of methicillin-resistant Staphylococcus aureus (MRSA) in 1980s, vancomycin has been widely used as the antibiotic of choice for MRSA infections. Adverse events known as related with vancomycin are red-man syndrome, ototoxicity, and nephrotoxicity. We studied the clinical and bacteriological efficacy and safety of generic vancomycin (Cheiljedang vancomycin®) in the treatment of infections caused by MRSA. Methods : During the period between April 1999 and September 2001, we prospectively enrolled 79 patients with established or suspected MRSA infection and evaluated the clinical and bacteriological efficacy and adverse events. Results : Total 42 patients were evaluable for MRSA infections. MRSA pneumonia (14/42; 33.3%) was the most common diagnosis, followed by skin &. soft tissue infection (9/42: 21.4%), primary bacteremia (5/42; 11.9%), and catheter-related infection (5/42; 11,9%). A favorable clinical response (cure or improved) occurred in 31 patients (75.6%) and a favorable bacteriological response (eradicated or presumed eradicated) occurred in 28 (68.3%) patients. MRSA infection related case fatality was 14.3%. The adverse events related to vancomycin were as follows; 2 patients (4.8%) with skin rash, 2 (4.8%) red-man syndrome, 2 nephrotoxicity, 2 leukopenia, and 1 thrombocytopenia. Conclusion : These results suggest that Cheiljedang vancomycin hydrochloride could be effective and safe as treatment for severe infections caused by MRSA.

메티실린 내성 황색 포도구균 유행발생시 병원직원에 대한 보균자 실태 및 유행차단효과 연구

오향순,이성은,김의종,이환종,오명돈,최강원 대한감염학회 2001 감염 Vol.33 No.3

Background : Methicillin-resistant Staphylococcus aureus (MRSA) is the major pathogen of nosocomial infections. There are many reports that MRSA nasal cariers play a major role in the transmission of MRSA. We studied to assess the nasal carriage rates, therapeutic effects of nasal carriers and control of MRSA outbreak in a tertiary, acute and educational hospital. Methods : From 1990 to 1997, eight MRSA epidemics were detected and investigated for outbreak control. We surveyed the MRSA colonization of anterior nares and hands of health care workers (HCW). MRSA was identified by staphylococcal broth, mannitol-salt-agar, Muller-Hinton-oxacillin agar. To identify the permanent carriers in the HCWs, the nasal swab was done weekly for 3 weeks. Two percent povidone iodine ointment or 2% mupirocin ointment was applied topically to treat the permanent MRSA nasal carriers. Results : Of eight MRSA outbreaks, five epidemics occured in the intensive care unit, all of them occurred in surgical departments and five of them occurred in winter seasons. For eight MRSA outbreaks, 351 HCWs were surveyed. The rates of transient carriers was 10.8% (38/351) and the rates of that were 9.0% (10/111) in medical doctors (MD), 12.5% (24/192) in registered nurses (RN) and 11.4% (4/35) in aid nurses (P=0.470). The rate of permanent carrier in doctors was 1.8%, and that in RNs was 3.7% (P=0.490). After topical therapy with 2% povidone iodine ointment or 2% mupirocin ointment for permanent carriers, MRSA was not identified for 2 months follow up. Conclusion : In MRSA epidemics, the rate of the transient carrier rate of MRSA in HCWs was 10.8% and the rate of the permanent carrier was 2.6%. The difference of carrier rates in HCWs was not significant statistically. The therapy for the permanent nasal carriers in HCWs with two percent povidone iodine ointment or 2% mupirocin ointment was very effective. And MRSA outbreaks were ended and controlled for 6months follow up. (Korean J Infect Dis 33: 194∼201, 2001)

Methicillin 내성 Staphylococcus aureus의 항생제 감수성 및 중합효소연쇄반응을 이용한 mecA 유전자의 검출

김명유,이정녀,함건주 대한임상병리학회 1996 대한임상병리학회지 Vol.16 No.5

Arbekacin의 methicillin 내성 Staphylococcus aureus와 Pseudomonas aeruginosa에 대한 항균력

정윤섭,이경원,신정원,신희봉,임종백 대한화학요법학회 1997 대한화학요법학회지 Vol.15 No.3

배경 : MRSA와 P. aeruginosao는 흔한 원내 감염균이고 aminoglycoside를 포함한 여러 항균제에 내성인 균주가 많다. Arbekacin은 aminoglycoside제로서 일본에서는 MRSA 감염을 치료를 위해 사용되고 있다. 이 연구에서는 MRSA가 확산되기 시작하던 시기와 근래에 분리된 MRSA에 대한, 그리고 내성양상에 따라서 선택된 P. aeruginosa에 대한 arbekacin의 항균력을 비교하고자 하였다. 방법 : 균주는 세브란스병원에서 분리하였다. P. aeruginosa 균주는 amikacin, ceftazidimie, imipenem 및 ciprofloxacin에 대해 감수성 혹은 내성인 것을 선택하였다. 감수성은 NCCLS 디스크 확산법 및 한천희석법으로 시험하였다. 결과 : Arbekacin≤14㎍/mL는 모든 MRSA 균주를 억제하였다. 1980년과 1996년에 분리한 MRSA에 대한 arbekacin의 MIC_(90)은 2㎍/mL로 같았고, MSSA에 대해서는 0.5 ㎍/mL이었다. MRSA가 높은 내성율을 보인 amicoglycoside부터 나열하면 kanamycin, gentamicin, tobramycin, amikacin, isepamicin의 순이었다. Amikacin 감수성인 P. aeruginosa에 대한 arbekacin의 MIC??은 amikacin 보다 약간 높았으나, ceftazidime, impenem 및 ciprofloxacin에 감수성 혹은 내성인 균주에 대해서 보다는 약간 낮았다. Arbekacin 감수성 균주의 비율은 다른 항균제에 대한 감수성이나 균주의 비율은 다른 항균제에 대한 감수성이나 내성인 균주 군에 따라서 약 1/3 내지 2/3이었다. 결론 : 본 시험관내 감수성 성적으로 볼 때, arbekacin은 MRSA 감염의 치료와, 일부 MRSA와 P. aeruginosa의 혼합감염 치료에 유효할 것으로 사료되었다. Background : Methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa are very prevalent nosocomial pathogens, often resistant to multiple drugs including various aminoglycosides. Arbekacin is an aminoglycoside used for the treatment of MRSA infections in Japan. The aim of study was to compare the activities of arbekacin against the MRSAs isolated currently and at the start of the spread, and against the selected isolates of P. aeruginosa susceptible or resistant to amikacin, ceftazidime, impenem and ciprofloxacin. Methods : The strains were isolated from Severance Hospital. The NCCLS disk diffusion and agar dilution tests were used and strains inhibited by 4 ㎍/mL of arbekacin was interpreted as susceptible and 16 ㎍/mL resistant. Results : Arbekacm ≤4 ㎍/mL inhibited all of the MRSAs tested. The MiC_(90)s for MRS4s isolated in 1980 and 1996 were equal; 2 ㎍/mL, while that for MSSA was 0.5 ㎍/mL. All of the MRSA were susceptible. The resistance rates. in descending order, were to kanamycin, gentamicin, tobramj-cin, amikacin and isepamicin. MIC,, of arbekacin for amikacin-susceptible P. aerugznosa m-as slightly higher than that of amikacin, but slightly lower than those for the strains both susceptible and resistant to ceftazidxme, imipenem and ciprofloxacin. Depending on the susceptibility groups of strains, approximate15 1/3 to 2/3 were susceptible to arbekacin. Conclusion : Arbekacin may be useful for the treatment of single MRSA infection and for some of the mixed infections of MRSA and P. aerugznosa.

병원과 지역사회에서 메티실린 내성 황색 포도상구균(methicillin-resistant Staphylococcus aureus) 감염의 임상 분자역학 연구

박정원,이종섭,송준영,김철현,엄중식,정희진,김우주,박승철 대한화학요법학회 2002 대한화학요법학회지 Vol.20 No.2

목적 : 국내에서 1990년대 이후 중요한 병원균으로 대두되고 있는 methicillin-resistant S. ureus(MRSA)는 주로 입원환자에서만 분리되는 것으로 알려져 있으나, 최근들어 지역사회에서도 퍼져있는 것으로 알려지기 시작하였다. 이에 병원획득 및 지역사회획득 MRSA의 임상역학 및 분자역학적 연구를 통하여 획득요인, 병원과 지역사회 획득 균주간의 교류 양상등을 규명하고자 하였다. 방법 : 1998년 1월부터 12월까지 고려대 부속 구로병원에서 임상검체로부터 분리된 S. aureus 균주중에서 MRSA 균주의 빈도를 구하였고, 이중 1998년 10월 1개월 동안 분리되었던 42균주에 대하여 지역사회획득 균주와 병원획득 균주로 나누고, 임상역학적 조사를 하였다. 지역사회 획득 18주와 병원획득 22주에 대하여 PCR 방법으로 mecA 유전자를 확인하였고, PFGE를 시행하여 균주의 클론형(clonal type)을 결정하고 이 결과에 준하여 덴드로그램 분석을 시행하여 분자적 친밀도를 결정하였다. 결과 : 1998년 1년간 분리된 총 1,587주의 S. aeureus 균주중 73.8%(1,163주)가 MRSA 였다. 1998년 10월 1개월 동안 임상자료의 고찰이 가능하였던 MRSA 감염환자 42명 중 20명이 지역사회획득 환자였고, 병원획득 환자가 지역사회획득 환자보다 항생제사용 과거력(17 vs 5, p=0.001), 기저질환의 존재(18 vs 8, p=0.002) 등이 통계적으로 의미있게 높았다. 지역사회획득환자가 이루(7/20[35.0%] vs 2/22[9.1%] ; p=0.041)와 밀접한 관계가 있음도 확인하였다. 분자생물학적연구가 진행된 40주의 MRSA 균주는 모두 mecA 유전자 양성이었고, 18주의 지역사회획득 균주에서 총 8가지의 PFGE 클론형이 존재하였으며 A형이 가장 많았다(7/18, 38.8%). 22주의 병원획득균주에서는 6가지의 클론형이 존재하고 A형이 가장 많았으며(15/22, 68%), 15주의 지역사회획득 균주(83.3%)가 21주의 병원획득균주와 공통적인 클론형을 공유하고 있었다. 결론 : 지역사회 획득 MRSA는 주로 이루나 창상부위에서 많이 분리되는 반면 병원획득 MRSA는 객담에서 많이 분리되고 또한 당뇨병을 가진 환자에서 감염을 잘 일으키는 것으로 밝혀졌다. PFGE 분석 결과 원내감염은 단일균주에 의한 유행양상을 보였고, 지역사회에서도 같은 형의 균주에 의한 감염빈도가 가장 높음을 보여 MRSA 균주가 지역사회로 유입되어 지역사회내 MRSA 감염의 발생에 기여했을 것으로 사료된다. Background : Until recently, methicillin-resistant Staphylococcus aureus (MRSA) infection has been acquired primarily in hospital settings. During the late 1990s, the incidence of community-acquired MRSA infections has been increased in this university hospital. This retrospective study evaluated the clinical features and risk factors for community-acquired MRSA infection compared with hospital-acquired MRSA infection; and molecular relatedness of MRSA strains determined by pulsed-field gel electrophoresis(PFGE). Method: MRSA isolates collected from patients during October of 1998 were classified as community-acquired("community') or hospital-acquired("hospital") cases. MRSA infections were defined as hospital-acquired if organisms were isolated > 48 hours after admission to the hospital or isolated from patients with a history of admission to a hospital within the last 3 months. A comparative analysis of risk factors for community MRSA compared with hospital MRSA was performed. mecA gene PCR and PFGE of MRSA isolated was used as a tool of strain identification and molecular typing. Result : During one month, there were 42 patients with MRSA infection or colonization. Of 42 patients with MRSA isolates, 22(52%) were hospital cases and 20(48%) were community cases. Previous exposure to antibiotics(17 vs 5, p = 0.001) and presence of underlying diseases (18 vs 8, p = 0.002) were more common in hospital cases than in community cases. MRSA were more frequently isolated in otorrhea specimens from patients with otitis media in community cases compared with hospital cases. Of the 40 MRSA isolates subjected for PFGE typing, 18 were community isolates and 22 were hospital isolates. There were 8 distinct PFGE types among the 18 community isolates and type A was the most common clonal type (7/18, 38.8%). 22 hospital isolates were of 6 distinct PFGE types, and type A was dominant clonal type (15/22, 68%). PGFE subtyping indicated that 15(83.3%) of 18 community MRSA strains were clonally related with that of 21 hospital MRSA strains. Conclusion : Our results suggest that hospital MRSA strains may have disseminated in the community setting. PFGE subtyping support the finding that MRSA is circulating beyond nosocomial settings in the regional community.

The Epidemiological Survey of Nasal Colonization of Methicillin Resistant Staphylococcus aureus in Patients and Doctors

Hee Kyung Seong,Young Soon Bae,Yong Ho KIm 대한의생명과학회 2004 Biomedical Science Letters Vol.10 No.3

Methicillin resistant Staphylococcus aureus (MRSA) is one of the most common nosocomial pathogens. Many hospitals are facing the problems which they have to use expensive antibiotics and suffer from long term hospital study of patients due to MRSA. This study is to survey MRSA nasal colonization of patients and doctors, and to investigate the mode of transmission of MRSA by pulsed field gel electrophoresis (PFGE) and then use these data to prevent further spread of cross infection and reduce nosocomial infection. Subjects of this study were 201 patients with MRSA infection at an university hospital in Busan from Sept. 1997 to Aug. 1998. Bacterial genotypes of MRSA strains isolated from nares and wound of patients (14 cases) and nares of doctors (8 cases) were analyzed by PFGE. Nasal cultures of 201 patients for detecting nasal colonization of MRSA were performed and incidence rate of nasal colonization was 40% (80/201). Among 201 patients MRSA were acquired from hospital in 140 (70%) patients and were acquired from community 61 (30%) patients. Among 14 pairs of MRSA from colonized or infected sites and anterior nares, DNA patterns of 10 pairs (71.4%) were equal. 86% (12/14) MRSA strains isolated from patients and 12.5% (1/8) MRSA strains isolated from doctors show same pattern. DNA patterns were changed in some doctors after nasal oint. Treatment. It could be inferred that the most sources of MRSA in hospital are the endemically existing MRSA. Therefore, we believe that it would be necessary to control MRSA nasal colonization of the patients and the related medical teams to reduce the medical cost and to improve the efficacy of medical cares.

메티실린 내성 황색포도알균이 토착화된 중환자실에서 비강보균자 검출을 위한 BD GeneOhm MRSA PCR Assay의 수행능 평가

박상혁,장윤하,성흥섭,김미나*,김재석,박연준 대한진단검사의학회 2009 Annals of Laboratory Medicine Vol.29 No.5

Background : The BD GeneOhm MRSA PCR assay (Becton Dickinson, USA) is a qualitative realtime PCR test for rapid detection of nasal colonization of methicillin-resistant Staphylococcus aureus (MRSA). We evaluated the performance of BD GeneOhm MRSA PCR assay versus MRSASelect (Bio-Rad, France) and broth enrichment cultures for detection of MRSA from nasal swabs. Methods : From August 2008 to January 2009, 295 nasal swabs were taken from patients in intensive care units and transported to the laboratory with BD CultureSwab Liquid Stuart Single Swab (Becton Dickinson, USA). The swabs were inoculated onto MRSASelect first and then suspended into GeneOhm sample buffer: 100 μL of the suspension was inoculated into 6.5% NaCl-tryptic soy broth (Becton Dickinson, USA), which was subcultured on MRSASelect after overnight incubation (TSBS). Performances of GeneOhm MRSA and MRSASelect were compared to TSBS. Results : With GeneOhm MRSA, 125 swabs (44.6%) were positive for MRSA, 13 (4.4%) were unresolved, and 2 were not determined. With MRSASelect and TSBS 86 (29.4%) and 106 swabs (36.2%), respectively, were positive. The sensitivity, specificity, and positive and negative predictive value of GeneOhm MRSA were 85.8%, 77.5%, and 72.8% and 93.5%, respectively, and corresponding values for MRSASelect were 78.3%, 94.8%, and 96.5% and 88.9%. Of the 33 patients whose 34 specimens were found false positive in GeneOhm MRSA, 23 patients were MRSA-positive either previously or subsequently to this study. All of the 10 patients with false-negative specimens in GeneOhm MRSA PCR assay were previously MRSA or methicilln-resistant coagulase negative staphylococci (MRCNS)-positive and were treated for MRSA, but they became MRSA-positive after 1 to 4 negative surveillance cultures. Conclusions : GeneOhm MRSA PCR assay showed a relatively high negative predictive value. However, its low specificity and frequent occurrence of unresolved results would be problematic in the endemic areas with a high prevalence of MRSA. 배경 : BD GeneOhmTM MRSA PCR assay (Becton Dickinson, USA)은 메티실린 내성 황색포도알균 비강보균자의 신 속한 검출을 위한 정성적 실시간 PCR 검사이다. 저자들은 전비 공 도말 검체에서의 MRSA 선별에 GeneOhm MRSA의 수행능 을 MRSASelect (Bio-Rad, France) 선별배지와 액체증균배지 에 비교하여 평가하였다. 방법 : 2008년 8월에서 2009년 1월 사이에 중환자실에서 의 뢰한 295개의 전비공 도말 검체를 대상으로 하였고, 이들은 BD CultureSwab Liquid Stuart Single Swab (Becton Dickinson, USA)으로 채취, 수송되었다. 전비공 도말 검체는 먼저 MRSASelect에 접종 후 GeneOhm 검체완충튜브에 풀었고 현탁액 100 μL을 6.5% NaCl을 첨가한 tryptic soy broth (Becton Dickinson, USA)에 접종하고 하룻밤 배양 후 MRSASelect 선 별배지에 계대배양하였다(TSBS). GeneOhm MRSA와 MRSASelect의 수행능을 TSBS에 비교하여 평가하였다. 결과 : GeneOhm MRSA는 125검체(44.6%)가 양성이었고 13검체(4.4%)가‘판독불가’, 2검체가‘작동오류’였다. MRSASelect와 TSBS는 각각 86검체(29.4%), 106검체(36.2%)가 양 성이었다. GeneOhm MRSA와 MRSASelect의 민감도/특이/ 양성예측도/음성예측도는 각각 85.8%/77.5%/72.8%/93.5%, 78.3%/98.4%/96.5%/88.9%이었다. 34개의 GeneOhm MRSA 위양성 검체는 33명의 환자에서 얻어졌고, 23명은 직전 또는 직 후 감시배양에서 MRSA 양성이었다. 10개의 GeneOhm MRSA 위음성 검체는 모두 이전에 MRSA 또는 메티실린 내성 coagulase negative staphylococci 양성이었으며 항 MRSA 항균 제 치료를 받았고 1-4회의 감시배양이 음성이다가 양성으로 전 환된 경우였다. 결론 : GeneOhm MRSA는 상대적으로 높은 음성예측도를 보이나 특이도가 낮고‘판독불가’결과가 존재하여 MRSA 유병 률이 높은 토착화된 장소에서 감시배양을 대치하는데 문제가 될 수 있다.

The Epidemiological Survey of Nasal Colonization of Methicillin Resistant Staphylococcus aureus in Patients and Doctors

Seong Hee Kyung,Bae Young Soon,Kim Yong Ho 대한의생명과학회 2004 Biomedical Science Letters Vol.10 No.3

Methicillin resistant Staphylococcus aureus (MRSA) is one of the most common nosocomial pathogens. Many hospitals are facing the problems which they have to use expensive antibiotics and suffer from long term hospital study of patients due to MRSA. This study is to survey MRSA nasal colonization of patients and doctors, and to investigate the mode of transmission of MRSA by pulsed field gel electrophoresis (PFGE) and then use these data to prevent further spread of cross infection and reduce nosocomial infection. Subjects of this study were 201 patients with MRSA infection at an university hospital in Busan from Sept. 1997 to Aug. 1998. Bacterial genotypes of MRSA strains isolated from nares and wound of patients (14 cases) and nares of doctors (8 cases) were analyzed by PFGE. Nasal cultures of 20 I patients for detecting nasal colonization of MRSA were performed and incidence rate of nasal colonization was 40% (80/201). Among 201 patients MRSA were acquired from hospital in 140 (70%) patients and were acquired from community 61 (30%) patients. Among 14 pairs of MRSA from colonized or infected sites and anterior nares, DNA patterns of 10 pairs (71.4%) were equal. 86% (12/14) MRSA strains isolated from patients and 12.5% (1/8) MRSA strains isolated from doctors show same pattern. DNA patterns were changed in some doctors after nasal oint. Treatment. It could be inferred that the most sources of MRSA in hospital are the endemically existing MRSA. Therefore, we believe that it would be necessary to control MRSA nasal colonization of the patients and the related medical teams to reduce the medical cost and to improve the efficacy of medical cares.

The Epidemiological Survey of Nasal Colonization of Methicillin Resistant Staphylococcus aureus in Patients and Doctors

Seong, Hee Kyung,Bae, Young Soon,Kim, Yong Ho THE KOREAN SOCIETY FOR BIOMEDICAL LABORATORY SCIEN 2004 Journal of biomedical laboratory sciences Vol.10 No.3

Methicillin resistant Staphylococcus aureus (MRSA) is one of the most common nosocomial pathogens. Many hospitals are facing the problems which they have to use expensive antibiotics and suffer from long term hospital study of patients due to MRSA. This study is to survey MRSA nasal colonization of patients and doctors, and to investigate the mode of transmission of MRSA by pulsed field gel electrophoresis (PFGE) and then use these data to prevent further spread of cross infection and reduce nosocomial infection. Subjects of this study were 201 patients with MRSA infection at an university hospital in Busan from Sept. 1997 to Aug. 1998. Bacterial genotypes of MRSA strains isolated from nares and wound of patients (14 cases) and nares of doctors (8 cases) were analyzed by PFGE. Nasal cultures of 201 patients for detecting nasal colonization of MRSA were performed and incidence rate of nasal colonization was 40% (80/201). Among 201 patients MRSA were acquired from hospital in 140 (70%) patients and were acquired from community 61 (30%) patients. Among 14 pairs of MRSA from colonized or infected sites and anterior nares, DNA patterns of 10 pairs (71.4%) were equal. 86% (12/14) MRSA strains isolated from patients and 12.5% (1/8) MRSA strains isolated from doctors show same pattern. DNA patterns were changed in some doctors after nasal oint. Treatment. It could be inferred that the most sources of MRSA in hospital are the endemically existing MRSA. Therefore. we believe that it would be necessary to control MRSA nasal colonization of the patients and the related medical teams to reduce the medical cost and to improve the efficacy of medical cares.