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Prävention von Methicillin-resistentem S. aureus durch Screeninguntersuchungen

Ergebnisse eines Workshops der Deutschen Gesellschaft für Hygiene und Mikrobiologie

Control of methicillin-resistant S. aureus by active surveillance

Results of a workshop held by the Deutsche Gesellschaft für Hygiene und Mikrobiologie

  • Intensivmedizin
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Zusammenfassung

In Deutschland ist seit Jahren eine kontinuierliche Zunahme von Methicillin-resistentem Staphylococcus (S.) aureus (MRSA) zu verzeichnen. Um eine weitere Ausbreitung von MRSA zu verhindern, werden Screeninguntersuchungen bei Aufnahme der Patienten ins Krankenhaus empfohlen. In den meisten Fällen ist ein Screening von Risikopatienten mit kulturellen mikrobiologischen Methoden ausreichend. Auf Intensivstationen mit einer hohen MRSA-Inzidenz (>2 Fälle/100 Patienten) und einem hohen Anteil nosokomialer MRSA-Infektionen (>0,3/100 Patienten) wird das Aufnahmescreening bei allen Patienten kosteneffektiv: Bei einer Reduktion nosokomialer MRSA-Infektionen um 50% ist hier eine Kosteneffektivität bis zu EUR 16/Abstrich (einschließlich Folgekosten), bei einer Reduktion nosokomialer MRSA-Infektionen um 75% bis zu EUR 24/Abstrich (einschließlich Folgekosten) gegeben. Das Screening mithilfe der Polymerase-Kettenreaktion (PCR) wird kosteneffektiv bei Risikopatienten mit einer hohen MRSA-Inzidenz und falls die Isolationsmaßnahmen prophylaktisch durchgeführt werden. Hier wurden Verfahren entwickelt, die eine eindeutige Identifikation von MRSA direkt aus Nasenabstrichen ermöglichen.

Abstract

In Germany, methicillin-resistant S. aureus (MRSA) is increasing continuously. To control the spread of MRSA, active surveillance and admission screening are recommended. In most cases, screening cultures of patients at risk for MRSA will be sufficient. Screening of all patients admitted to an ICU is cost-effective when the incidence of MRSA and nosocomial MRSA infections is high (>2 cases/100 patients and 0.3 MRSA infections/100 patients, respectively): Under these circumstances, a decrease in the incidence of nosocomial MRSA infections of 50% leads to cost-effectiveness at costs of 16 Euro/sample (including subsequent costs). If the incidence of nosocomial MRSA infections decreases by 75%, costs of 24 Euro/sample (including subsequent costs) are cost-effective. If the incidence of MRSA is high, screening by PCR may be cost-effective for patients at high risk for MRSA, especially if they are isolated prophylactically. Recently, PCR methods have been developed which allow the specific identification of MRSA even from nasal swabs.

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Authors and Affiliations

  1. Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Medizinische Hochschule, Carl-Neuberg-Str. 1, 30625, Hannover

    A. Kola, I. F. Chaberny, F. Mattner, R.-P. Vonberg, S. Ziesing, S. Suerbaum & P. Gastmeier

  2. Institut für Medizinische Mikrobiologie und Hygiene, Universität, Regensburg

    U. Reischl

  3. Institut für Hygiene und Umweltmedizin, Charité – Universitätsmedizin, Berlin

    K. Weist

  4. Institut für Hygiene, Universitätsklinikum, Heidelberg

    C. Wendt

  5. Robert Koch-Institut, Bereich Wernigerode

    W. Witte

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  1. A. Kola
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  2. I. F. Chaberny
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  3. F. Mattner
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  4. U. Reischl
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  5. R.-P. Vonberg
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  7. C. Wendt
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  8. W. Witte
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  9. S. Ziesing
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  11. P. Gastmeier
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Correspondence to A. Kola.

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Kola, A., Chaberny, I.F., Mattner, F. et al. Prävention von Methicillin-resistentem S. aureus durch Screeninguntersuchungen. Anaesthesist 55, 778–783 (2006). https://doi.org/10.1007/s00101-006-1016-5

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