Follow up of MRSA patients at the Institute of Oncology Ljubljana

Abstract

Methicillin-resistant Staphylococcus aureus (MRSA) is considered to be the most frequent agent of nosocomial infections. It may be spread through physical contacts of hospital staff with patients. Antibiotic treatment possibilities are limited. Most frequently, glycopeptides antibiotics are used; however, their bactericidal effect is inadequate. Cancer patients are known to have weakened immune systems due to the disease itself and also to cancer therapies. They are therefore at greater risk for infection than other patients. Additional infection risks in cancer patients are also undernourishment, invasive diagnostic and therapeutic interventions, frequent hospitalizations, etc. In the prevention of further spread of MRSA, it is of utmost importance to follow strictly the measures, such as hand hygiene, identification of patients who are at risk to be MRSA carriers, isolation and decolonization of the patients at risk and sensible use of antibiotics. The data on MRSA occurrence in a hospital are viable indicators of the level of hospital hygiene.
At the Institute of Oncology Ljubljana, regular identification of patients who are at risk of infection with MRSA has been carried out from 2004. Most frequently, MRSA has been detected in a surgical or chronic wound and the most frequent risk factor has been hospitalization, in particular at surgical wards. Fortunately, the MRSA incidence has been found to decline in most recent years.

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Povzetek

Meticilin rezistenten Staphylococcus aureus (MRSA) je pomemben povzročitelj bolnišničnih okužb. Širi se predvsem prek rok zdravstvenega osebja in bolnikov. Možnosti antibiotičnega zdravljenja so omejene. Najpogosteje uporabljamo glikopeptidne antibiotike, ki imajo slab baktericidni učinek. Onkološki bolniki imajo zaradi bolezni in postopkov zdravljenja oslabljene obrambne mehanizme, zato so bolj nagnjeni k okužbam. Dodatni dejavniki tveganja za okužbo so slaba prehranjenost, invazivni diagnostični in terapevtski posegi, pogoste hospitalizacije itd.
Pomembno je dosledno izvajanje ukrepov za preprečevanje širjenja MRSA: higiena rok, iskanje bolnikov z dejavniki tveganja za nosilstvo MRSA, izolacija in dekolonizacija bolnika ter racionalna uporaba antibiotikov. Pogostnost pojavljanja MRSA je kazalec uspešnosti bolnišnične higiene.
Na Onkološkem inštitutu izvajamo aktivno iskanje bolnikov z dejavniki tveganja od leta 2004. Prisotnost MRSA je bila največkrat ugotovljena v pooperativni ali kronični rani. Najpogostejši dejavnik tveganja je predhodna hospitalizacija, zlasti na kirurških oddelkih. Število bolnikov z MRSA v zadnjih letih upada.