Artikel
A strict protocol for the prevention of methicillin-resistant staphylococcus aureus (MRSA) colonization/infection on a neurosurgical intensive care unit
Ein Protokoll zur Vorbeugung von Kolonisationen/Infektionen mit Methicillin resistenten Staphylokokken auf einer neurochirurgischen Intensivstation
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Autoren
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T. Kral
- Neurochirurgische Klinik, Universitätsklinik Bonn
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M. Kleinpoppen
- Neurochirurgische Klinik, Universitätsklinik Bonn
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S. Engelhart
- Institut für Hygiene, Universitätsklinik Bonn
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A. Aliashkevich
- Neurochirurgische Klinik, Universitätsklinik Bonn
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C. Schaller
- Neurochirurgische Klinik, Universitätsklinik Bonn
| Veröffentlicht: | 4. Mai 2005 |
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Gliederung
Text
Objective
MRSA colonization or infections pose a growing problem on intensive care units (ICU). It was the aim of the study to analyse the incidence of MRSA colonization and infection in a neurosurgical intensive care unit upon introduction of a strict protocol for the prevention of infection.
Methods
A total of 4132 patients were admitted to the ICU within the five-year-period of time from 1999 to 2003 and prospectively enrolled in an EXCEL database containing data regarding sites and results of microbiological testing. This allowed for identification of MRSA-colonized/-infected patients. The following protocol for detection and eradication was established: On admission and twice weekly all patients on the ICU were screened for MRSA by swabs taken from their nose, throat, perineum, as well as cultures of urine and cerebrospinal fluid (CSF). All patients who had to stay longer than 3 days on the ICU, and all patients with MRSA-positive cultures were treated with intranasally applied octenidine hydrochloride lotion. The MRSA-positive cases were isolated and systemic antibiotic drugs based on microbiological testing were administered. A patient was deemed free of MRSA infection after three sets of negative swab/culture results.
Results
There were 25 patients (0.6%) with positive MRSA cultures, which were equally distributed over the 5 years investigated. MRSA was mostly (52%) detected within 5 days after admission. Beside a colonization of the nose (N=19), throat (N=21) and perineum (N=1), MRSA infections manifested as bronchopneumia (N=9), meningitis (N=3), wound infection (N=2) and cystitis (N=1). In addition, MRSA was isolated from central venous catheters (N=5) and blood culture (N=1). MRSA were eradicated in six patients, and another six patients died of causes unrelated to MRSA colonization. MRSA was not eradicated at the time of discharge to other hospitals in the remaining 13 patients.
Conclusions
A strict detection and eradication protocol practiced in this series, led to a low incidence of MRSA colonization/infection compared to the incidence available from the literature.
