Ältere Menschen sind gegenüber invasiven Infektionen und Sepsis besonders vulnerabel mit ungünstiger Prognose. Staphylococcus aureus und Haemophilus influenzae können beide invasive Infektionen verursachen. Oft geht eine asymptomatische Besiedelung einer Infektion voraus und ist ein Risikofaktor für eine invasive Infektion. Daher wurde eine bizentrische Querschnittstudie in den Regionen Aachen und Würzburg durchgeführt, um die Prävalenz von H. influenzae, S. aureus und MRSA (Methicillin resistenter S. aureus) bei asymptomatischen Senioren zu bestimmen, wie auch Risikofaktoren für eine Besiedelung. Von Oktober 2012 bis Mai 2013 wurden 677 Erwachsenen im Alter von 65 Jahren oder älter eingeschlossen, die zu Hause oder in Seniorenheimen lebten. Die Prävalenz von H. influenzae bei älteren Menschen war mit einer Trägerrate von nur 1,9% ([95% CI: 1,0 - 3,3%]; 13/677) sehr niedrig. Trägerisolate waren überwiegend nicht typisierbare H. influenzae, zeigten eine hohe clonale Diversität und waren alle Ampicillin-sensibel. Die Prävalenz von S. aureus war mit 28,5% ([95% CI: 25,1 - 32,1%]; 193/677) hoch, wie für die deutsche Allgemeinbevölkerung bekannt, während MRSA bei weniger als 1% der Teilnehmer gefunden wurde (0,7% [95% CI: 0,2 - 1,7%]; 5/677). Die Prävalenz von H. influenzae, S. aureus und MRSA unterschied sich nicht signifikant zwischen selbständig zu Hause lebenden Senioren und Pflegeheimbewohnern. Ältere, selbständig lebende Menschen mit höherem Bildungsniveau hatten signifikant höhere Kolonisierungsraten mit S. aureus (adjusted OR: 1,905 [95% CI: 1,248 - 2,908]; p = 0,003). Bei Pflegeheimbewohnern war eine Kolonisierung signifikant mit Verheiratet sein assoziiert (adjusted OR: 3,367 [95% CI: 1,502 - 7,546]; p = 0,003). Diese Ergebnisse unterstreichen die Bedeutung von sozio-demographischen Faktoren für eine Kolonisierung mit S. aureus und schließen eine Lücke bei epidemiologischen Daten zu H. influenzae. / Elderly people are especially vulnerable to invasive infections and sepsis with often poor outcome. Staphyloccus aureus and Haemophilus influenzae both can cause invasive infections. Asymptomatic colonization often precedes infection and poses a risk for invasive infection. Therefore, a bi-centric cross-sectional carrier study was conducted in the regions of Aachen and Wuerzburg, Germany, to determine the prevalence of H. influenzae, S. aureus and MRSA (methicillin resistant S. aureus) in asymptomatic elderly people and to identify risk factors for colonization. From October 2012 to May 2013 677 adults aged 65 years and older were included, living at home or in nursing homes. In contrast to children and younger adults the prevalence of H. influenzae was very low among elderly people with a carriage rate of only 1.9% ([95% CI: 1.0 - 3.3%]; 13/677). Carrier isolates were predominantly non typeable H. influenzae, showed a high clonal diversity and were all susceptible to ampicillin. The prevalence of S. aureus was expectedly high as known for the German general population (28.5% [95% CI: 25.1 - 32.1%]; 193/677), while MRSA was found in less than 1% of the individuals (0.7% [95% CI: 0.2 - 1.7%]; 5/677). The prevalence of H. influenzae, S. aureus und MRSA did not differ significantly between community dwellers and nursing home residents. Elderly community-dwellers with higher education level had significantly higher colonization rates with S. aureus (adjusted OR: 1.905 [95% CI: 1.248 - 2.908]; p = 0.003). Among nursing home residents, colonization was significantly associated with being married (adjusted OR: 3.367 [1.502 - 7.546]; p = 0.003). These results underline the importance of socio-demographic factors for colonization with S. aureus and close a gap in epidemiological data on H. influenzae.

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Systemische Infektionen mit S. aureus (MSSA und MRSA) und Infektionen des Gefäßzugangs bei HD-Patienten sind eine der wichtigsten Ursachen für Morbidität und Mortalität in dieser speziellen Population. Infektionsrisikos stellen die zunehmende Verwendung von Fremdkörpern, wie Katheter und Graft als Gefäßzugänge, sowie die intensivmedizinische Behandlung bei älteren und multimorbiden Patienten dar. Unter den bakteriell bedingten Infektionen bleiben Staphylokokken der am häufigsten nachgewiesene Stamm. Mit dem zunehmenden Gebrauch von Vancomycin zur Behandlung von MSSA-Infektionen hat das Vorkommen von MRSA zugenommen. Dies macht die Entwicklung von alternativen Antibiotikaregimen nötig, die eine Selektion von MRSA-Spezies verhindern. Unter dieser Überlegung wurde auf die Behandlung mit Vancomycin bei Zugangs-bezogenen Infektionen verzichtet. Es wurde im Jahr 2000 durch ein Standardregime bestehend aus Flucloxacillin und Rifampicin ersetzt. Mithilfe eines Screeningprogramms wurde nach MSSA- (n=88) und MRSA- (n=1) Kolonisationen gesucht. Dies gelang mit Hilfe von Querschnitts-Screenings und Indikations-Screeninguntersuchungen bei Aufnahme über den Zeitraum von 2000 bis 2010. Eine Besiedlung mit MRSA wurde bei nur einem Patienten während des 10-Jahres-Screenings registriert. Die gefundenen MSSA-Kolonisationen bei HD-Patienten beeinflussten die Morbidität und Mortalität nicht. Die Anzahl an HD-Patienten mit MSSA-Kolonisation nahm während des Beobachtungszeitraums von zehn Jahren ab Behandlungen mit dem Vancomycin-freien Regime waren generell erfolgreich und resultierten in einem Rückgang der klinischen und laborativen Infektionsmarker und/oder negativen Blutkulturen. Es konnte gezeigt werden, dass mit dem Gebrauch von vancomycinfreien Antibiotikaregimen ein erfolgreiches Management von Staphylokokkus-assoziierten Zugangsinfektionen bei HD-Patienten möglich ist.

Bakgrund: Smittspridning av Meticillinresistenta Staphylococcus Aureus har under de senaste åren ökat vilket ställer högre krav på hälso- och sjukvårdspersonals följsamhet av riktlinjer beträffande vårdhygien. Studier visar att följsamhet till riktlinjer är låg vilket orsakar patientlidande och högre kostnader för hälso- och sjukvården. Syfte: Att belysa faktorer som påverkar hälso- och sjukvårdspersonals följsamhet av riktlinjer vid MRSA på sjukhus. Metod: Litteraturöversikt som baseras på kvalitativa (n=3), kvantitativa (n=7) samt mixad metod (n=3) av vetenskapliga artiklar. Resultat: Ur analysen av datamaterialet framträdde fyra kategorier; kunskap, arbetsmiljö, organisation och negativt förhållningssätt, med nio underkategorier. Slutsats: Kunskap gällande smittspridning av MRSA hos hälso- och sjukvårdspersonal ökar följsamheten av riktlinjer vid vårdhygienrutiner varför det är av betydelse att utbildning, god kommunikation och information erbjuds kontinuerligt. En bättre kunskapsnivå inom detta område ger trygghet i professionen och torde därför även förbättra personalens förhållningssätt till patienter, anhöriga och medarbetare. Hälso- och sjukvården står inför en stor utmaning då underbemanning och överbeläggningar är vanligt förekommande vilket även medför att placering av hygienutrustning brister. Organisationen har ett betydande ansvar för att skapa struktur och förutsättningar till att förbättra faktorer som hindrar personal att arbeta optimalt mot följsamhet av de riktlinjer som finns angivna beträffande smittspridning av MRSA. / Background: Transmission of Meticillinresistenta Staphylococcus Aureus has increased in recent years, which places greater demands on health professionals’ adherence to guidelines for infection control. Several studies shows that adherence to guidelines is low which is causing the patient suffering and higher costs for healthcare service. Aim: To illuminate factors that influence health professionals’ adherence to guidelines on MRSA in hospital care. Method: This literature review is based on qualitative (n=3) quantitative (n=7) and mixed method (n=3) scientific articles. Findings: Four categories emerged; knowledge, work environment, organization and negative approach, with nine subcategories. Conclusion: To increase adherence to guidelines regarding MRSA, education, communication and information is required continuously. Increased knowledge would improve health professionals’ approach to patients, relatives and employees, which in turns create confidence in their profession. This might also create opportunities to reduce the staffs concerns of being infected or spreading the infection to family members. Healthcare service is facing a great challenge where understaffing, overcrowding and placement of equipment deficiencies. The organization has a significant responsibility to create structure and conditions for an active and committed leadership to improve factors that may affect the spread of MRSA.

Os objetivos do presente estudo foram: a) avaliar a frequência de isolamentos de patógenos causadores de mastite em rebanhos leiteiros comerciais; b) determinar a susceptibilidade antimicrobiana de Staphylococcus spp. e Streptococcus spp. isolados de casos de mastite subclínica c) avaliar o perfil de multirresistência de Staphylococcus spp. e Streptococcus spp. d) Detectar o gene mecA em Staphylococcus spp. resistentes a oxacilina/meticilina; e) avaliar a associação entre as práticas de manejo e tratamento de mastite e a susceptibilidade antimicrobiana de Staphylococcus aureus isolados de rebanhos leiteiros. Foram selecionados para o presente estudo 13 rebanhos leiteiros a partir de um total de 60 rebanhos vinculados a um laticínio da região de Pirassununga/SP. Questionários previamente formulados foram respondidos pelos responsáveis do rebanho para avaliar a associação entre as práticas de manejo e tratamento de mastite e a susceptibilidade antimicrobiana de S. aureus. Após a seleção dos rebanhos e aplicação dos questionários, 1069 amostras de leite compostas foram coletadas durante 24 meses, em quatro períodos para realização de cultura e identificação dos patógenos, testes de susceptibilidade antimicrobiana e detecção do gene mecA. Os testes de susceptibilidade foram realizados em todos os isolados de Staphylococcus spp. e em 50% de Streptococcus spp. selecionados aleatoriamente. Os antimicrobianos testados foram: ampicilina 10 mg; clindamicina 2 &micro;g, penicilina 1 mg; ceftiofour 30 &micro;g; gentamicina 10 mg; sulfatrimetropin 25 &micro;g, enrofloxacina 5 &micro;g; sulfonamida 300 &micro;g, tetraciclina 30 &micro;g; oxacilina 1 mg; cefalotina 30 &micro;g e eritromicina 5 &micro;g. Todos os isolados de Staphylococcus spp. que apresentaram resistência a oxacilina/meticilina foram avaliados quanto à presença do gene mecA. Entre os isolados, Staphylococcus coagulase negativa foi o mais prevalente (28,6%), seguido por S. aureus (27,8%) e Corynebacterium spp. (10,9%). A susceptibilidade antimicrobiana dos isolados de S. aureus foi de 95,23% (eritromicina), 93,33% (cefalotina) e 65,71% (ampicilina). A susceptibilidade antimicrobiana dos isolados de Staphylococcus coagulase negativa (SCN) foi de 93,33% (cefalotina), 89,91% (eritromicina) e 62,03% (ceftiofur). Entre os isolados de Staphylococcus coagulase positiva (SCP), a susceptibilidade antimicrobiana foi de 93,33% (eritromicina), 91,11% (clindamicina e sulfonamida). A susceptibilidade antimicrobiana dos isolados de Streptococcus agalactiae foi de 38,46% (ampicilina) e 50% (sulfatrimetropin) e os isolados de S. dysgalactiae apresentaram susceptibilidade à tetraciclina de 19,44% e a clindamicina de 47,22%. A multirresistência foi maior entre os isolados de SCN (20,3%) e S.aureus (15,7%). Não foi detectado o gene mecA em nenhum dos isolados de Staphylococcus spp. Houve associação entre as variáveis para os seguintes antimicrobianos: a) tratamento de mastite clínica: ampicilina (P = 0,0055), ceftiofur (P = 0,0481), sulfatrimetropin (P= 0,0293), sulfonamida (P = 0,0043) e tetraciclina (P = 0,0058); e envio de amostras para cultura e antibiograma: ampicilina (P=0,0032), tetraciclina (P=<0,0001). Os principais fatores de risco para susceptibilidade antimicrobiana de S. aureus foram o não envio de amostras para cultura e antibiograma para tetraciclina (OR=6.012), penicilina (OR=4.687), eritromicina (OR=3.059) e ampicilina (OR=2.571), tratamento de mastite clínica para ampicilina (OR=2.178), ceftiofur (OR=1.956), gentamicina (OR=1.668), oxacilina (OR= 1.132) e penicilina (OR= 1.261) e tratamento de vaca seca para enrofloxacina (OR=2.111) e tetraciclina (OR=2.075). Os microrganismos mais frequentemente isolados foram Staphylococcus coagulase negativa e S. aureus. Os testes de susceptibilidade realizados para as espécies de Staphylococcus spp. e Streptococcus spp. apresentaram alta susceptibilidade para a maioria dos antimicrobianos testados. Com exceção de Streptococcus agalactiae para ampicilina e sulfatrimetropin e os isolados de S. dysgalactiae para tetraciclina e clindamicina. A maioria dos Staphylococcus spp. e Streptococcus spp. não apresentaram perfil de multirresistência. Nenhum dos isolados de Staphylococcus spp. fenotipicamente resistentes a oxacilina/meticilina apresentaram o gene mecA. O maior fator de risco associado à susceptibilidade de S. aureus foi em relação à tetraciclina, penicilina, eritromicina e ampicilina para o não envio de amostras para cultura e antibiograma. Dois fatores de risco importantes identificados foram relacionados à ampicilina, ceftiofur, gentamicina, oxacilina e penicilina para o tratamento de mastite clínica e à enrofloxacina e tetraciclina para o tratamento de vaca seca. / The aims of this study were: a) to evaluate the frequency of mastitis pathogens in commercial dairy herds, b) to determine the antimicrobial susceptibility of Staphylococcus spp. and Streptococcus spp. isolated from subclinical mastitis c) to evaluate the profile of multidrug resistance of Staphylococcus spp. and Streptococcus spp. d) to detect the mecA gene in Staphylococcus spp. resistant to oxacillin / methicillin, e) to evaluate the association between management practices and treatment of mastitis, and antimicrobial susceptibility of Staphylococcus aureus isolates from dairy herds. Thirteen dairy herds were selected from a total of 60 dairy farms in the region of Pirassununga / SP. Questionnaires formulated previously were answered by dairy farmers to evaluate the association between mastitis treatment practices and antimicrobial susceptibility. A total of 1,069 composite samples of milk from all herds were collected for culture and identification of pathogens, susceptibility testing and mecA gene detection, over 24 months in four periods. The susceptibility tests were performed in all isolates of Staphylococcus spp. and in 50% of Streptococcus spp. randomly selected. The antimicrobials tested were ampicillin 10mg; 2&micro;g clindamycin, penicillin 1mg; ceftiofour 30&micro;g; gentamicin 10mg; sulfatrimetropin 25&micro;g, 5&micro;g enrofloxacin; 300&micro;g sulfonamide, tetracycline 30&micro;g; oxacillin 1mg; 30&micro;g cephalothin and erythromycin 5&micro;g. All Staphylococcus spp. that were resistant to oxacillin/methicillin in the susceptibility tests were investigated for the presence of mecA gene. Among the isolated bacteria, CNS was the most prevalent (28.6%), followed by S. aureus (27.8%) and Corynebacterium spp. (10.9%). The antimicrobial susceptibility of isolates of S. aureus was 95.23% (erythromycin), 93.33% (cephalothin) and 65.71% (ampicillin). The antimicrobial susceptibility of isolates of coagulase-negative Staphylococcus (CNS) was 93.33% (cephalothin), 89.91% (erythromycin) and 62.03% (ceftiofur). Among strains of coagulase positive Staphylococcus (CPS), the antimicrobial susceptibility was 93.33% (erythromycin), 91.11% (clindamycin and sulfonamide). The antimicrobial susceptibility of the strains of Streptococcus agalactiae was 38.46% (ampicillin) and 50% (sulfatrimetropin) and isolates of S. dysgalactiae were susceptible to tetracycline and clindamycin (19.44% to 47.22%). The multidrug resistance was higher among isolates of CNS (20.3%) and Staphylococcus aureus (15.7%). The mecA gene was not detected in any of Staphylococcus spp isolates. There was an association between variables for the following antimicrobials: a) treatment of clinical mastitis: ampicillin (P = 0.0055), ceftiofur (P = 0.0481), sulfatrimetropin (P = 0.0293), sulfonamide (P = 0.0043) and tetracycline (P = 0.0058); and sending samples for culture and antibiogram: ampicillin (P = 0.0032), tetracycline (P = <0.0001). Major risk factors for antimicrobial susceptibility of S. aureus were not submitting samples for culture and antibiogram for tetracycline (OR = 6.012), penicillin (OR = 4.687), erythromycin (OR = 3.059) and ampicillin (OR = 2.571), treatment of clinical mastitis: ampicillin (OR = 2.178), ceftiofur (OR = 1.956), gentamicin (OR = 1.668), oxacillin (OR = 1.132) and penicillin (OR = 1.261); and dry cow therapy: enrofloxacin (OR = 2.111) and tetracycline (OR = 2.075). The most frequent organisms isolated were coagulase negative Staphylococcus and S. aureus. The susceptibility tests performed for the species of Staphylococcus spp. and Streptococcus spp. showed high susceptibility to most antimicrobials tested. With the exception of Streptococcus agalactiae to ampicillin and sulfatrimetropin and isolates of S. dysgalactiae to tetracycline and clindamycin. Most Staphylococcus spp. and Streptococcus spp. did not show multidrug resistance profile. None of Staphylococcus spp. phenotypically resistant to oxacillin / methicillin showed the mecA gene. The major risk factor associated with susceptibility of S. aureus to tetracycline, penicillin, erythromycin and ampicillin was not sending samples for culture and sensitivity. Two important risk factors have been identified related to ampicillin, ceftiofur, gentamicin, penicillin and oxacillin for treatment of clinical mastitis and enrofloxacin and tetracycline for the treatment of dry cow dry cow therapy.

Estima-se que 30% da população mundial esteja colonizada por Staphylococcus aureus. Indivíduos portadores de HIV/AIDS possuem maiores riscos de colonização e infecções causadas por S. aureus resistente à meticilina (MRSA), devido a seu estado imunológico comprometido, frequente uso de antibióticos e reinternações hospitalares. Linhagens de MRSA emergiram na década de 60, logo após a introdução da meticilina, devido a aquisição de genes que codificam proteínas ligadoras de penicilinas modificadas, mecA e mecC, contidos no elemento genético móvel SCCmec (do inglês, Staphylococcal Cassete Chromossome). Este estudo buscou caracterizar amostras de MRSA de pacientes com HIV/AIDS, isoladas no primeiro e sétimo dia de internação no hospital, e de seus profissionais de saúde, do Hospital das Clínicas de Ribeirão Preto, no período de abril de 2011 a maio de 2013. Os objetivos foram caracterizar fenotípica e genotipicamente os isolados de MRSA e comparar as linhagens, a fim de observar se havia disseminação entre os pacientes ou entre estes e profissionais de saúde relacionados. Foi realizada caracterização por perfil de sensibilidade, determinação do elemento SCCmec, eletroforese em campos pulsados (PFGE, do inglês, Pulsed Field Gel Electrophoresis) e tipagem por sequenciamento de Multilocus (MLST). Foram pesquisados os tipos de hemólise produzidos e a presença de gene para produção da Leucocidina Panton Valentine (PVL). Vinte pacientes encontravam-se colonizados no primeiro dia de internação, treze após uma semana e três profissionais da saúde estavam colonizados durante o estudo. Quando excluídas as amostras consideradas duplicatas, SCCmecIV foi o elemento predominante. Grande variedade clonal de MRSA foi encontrada nos pacientes, totalizando 11 pulsotipos. ST239-SCCmecIII, relacionado ao Clone Endêmico Brasileiro (BEC), foi isolado de pacientes logo no primeiro dia de internação, provavelmente devido à prévia internação. O profissional de saúde P1 apresentou colonização por MRSA caracterizado como pulsotipo E, que persistiu após o tratamento para descolonização. P1 foi tratado novamente e posteriormente foi observado isolado com pulsotipo J, sugerindo ser um clone diferente dos anteriores, mas ainda com linhagem ST105-SCCmecII. Apenas um isolado, do paciente 5, apresentou grande similaridade (92,3%) com um isolado do profissional de saúde (P1). Entretanto, houve intervalo de 10 meses entre as coletas e não há indício de transmissão direta de uma pessoa para outra. Presença do gene da PVL foi encontrada em apenas dois isolados. Três amostras de MRSA foram caracterizadas como hVISA (do inglês, heterogeneous Vancomycin Intermediate Staphylococcus aureus) e dois deles possuíam resistência intermediária à teicoplanina. Um isolado apresentou resistência à daptomicina em 48h de incubação com uma população heterogênea detectada. Todos foram sensíveis a quinupristina-dalfopristina, linezolida e tigeciclina. Concluímos que não houve disseminação de uma linhagem específica entre os pacientes, ou entre profissionais de saúde e pacientes e não foi observada relação entre o tempo de estadia no hospital e aquisição de uma linhagem em específico. No entanto, algumas linhagens com perfis de resistência muito preocupantes, como hVISA e com heterorresistência à daptomicina, foram isoladas e requerem atenção e monitoramento, com programas de vigilância e adoção de práticas de segurança e higiene no trabalho por parte dos profissionais de saúde. / It is estimated that 30 % of the world population is colonized by Staphylococcus aureus. Individuals with HIV/AIDS have a higher risk of colonization and infection caused by methicillin-resistant S. aureus (MRSA), due to their compromised immune system, frequent use of antibiotics and hospital readmissions. Strains of MRSA emerged in the 60s, shortly after the introduction of methicillin. Such resistance is caused by acquisition of genes encoding modified penicillin binding proteins, mecA and mecC, contained in the mobile genetic element SCCmec (Staphylococcal Cassette Chromosome). This study aimed to characterize MRSA isolated from patients with HIV/AIDS, in the first and seventh day of hospitalization, and their health care professionals, at the Clinical Hospital of Ribeirão Preto, in the period of April 2011 to May 2013. The objectives were to characterize phenotypic and genotypically MRSA isolates in order to observe if there was some lineage spread among patients or between these and related health professionals. MRSA isolates were characterized by susceptibility profile, SCCmec element typing, pulsed field gel electrophoresis (PFGE) and multilocus sequencing typing (MLST). Pattern of hemolysis and the presence of the gene for production of Leukocidin Panton Valentine (PVL) were determined. Twenty patients were colonized on the first day of hospitalization, thirteen patients in a week and only three health care professionals were colonized during the study. SCCmecIV was the predominant element when samples considered duplicates were excluded. Large variety of MRSA clones was found in patients with 11 pulsotypes. ST239-SCCmecIII, related to Brazilian Endemic Clone (BEC), was isolated from patients on the first day of hospitalization, probably due to previous hospital admission. Professional P1 was colonized by MRSA isolate characterized as pulsotype E which persisted after treatment for decolonization. P1 was treated again and was observed with a pulsotype J isolate, which suggests being a different clone of the same lineage ST105-SCCmecII. Only one sample, from patient 5, showed high similarity (92.3 %) with this health professional isolate (P1). However, there was an interval of 10 months between the collections and there is no evidence of direct transmission from one person to another. Presence of the PVL gene was found in only two isolates. Three MRSA isolates were characterized as hVISA (heterogeneous Vancomycin Intermediate S. aureus) and two of them were also intermediate resistant to teicoplanin. One isolate showed resistance to daptomycin in 48h incubation and heterogeneous population was detected. All isolates were susceptible to quinupristin-dalfopristin, linezolid and tigecycline. We conclude that no spread of a particular strain was found among patients or between health care professionals and patients, and no relationship between duration of hospital stay and acquisition of a specific lineage was observed. However, some strains with resistance profiles very threatening, as hVISA and heteroresistant to daptomycin, were isolated and require attention and monitoring, with surveillance programs and use of safety practices and hygiene by health professionals.

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Meticillinresistente gule stafylokokker (MRSA)er assosiert med økt risiko for komplikasjoner og død. I Norge anbefales omfattende smitteverntiltak for å forebygge spredning av MRSA i helseinstitusjoner, inklusiv i sykehjem. Tidligere ble det anbefalt å isolere MRSA-positive sykehjemsbeboere på enerom. I nasjonal MRSA-veileder publisert i 2009 frarådes langvarig isolering. Målet med studien var å undersøke om nye anbefalinger om ikke å isolere beboere med MRSA er like effektive som tidligere anbefalinger om å isolere beboere med MRSA, i forhold til å forebygge spredning av MRSA blant beboere i sykehjem. Metode: Studien er en non-inferiority kohortstudie basert på historiske data om registrerte MRSA-tilfeller ved sykehjem i Norge, informasjon om smitteverntiltak ved hvert sykehjem og statistikk om ressursbruk i kommunenes pleie-og omsorgstjenester. Hovedresultat: Insidensratene for sekundærtilfeller av samme MRSA spa-type ved samme sykehjem i løpet av oppfølgingstiden var 6.3 per 1000 beboerår på sykehjem som ikke isolerte og 18.5 per 1000 beboerår på sykehjem som isolerte beboere med MRSA. Insidensrate ratio for nytt MRSA-regime versus tidligere MRSA-regime var på 0.34 (95 % konfidensintervall: 0.17 –0.63). Konklusjon: Studiens resultat tilsier at nytt MRSA-regime uten isolering er like effektivt i å forebygge spredning av MRSA som tidligere MRSA-regime der beboere med MRSA ble isolert. Resultatene i studien bør benyttes aktivt for å få alle sykehjem i Norge til å implementere rutiner som er i tråd med anbefalinger i gjeldende nasjonal MRSA-veileder. / Methicillin-resistant Staphylococcus aureus(MRSA) associates with increased risk of morbidity and mortality. In Norway,public health officials recommend comprehensive infection control measures to prevent the spread of MRSA in healthcare institutions, includingnursing homes. Previous recommendations advisedsingle-room isolation for MRSA-positive nursing home residents. National MRSA-guidelines (2009)recommended avoidinglong-time isolation. Aim: Thisstudy aimed to determine whether the new MRSAregime,which no longer requires isolation ofresidents with MRSA,was equally effective as the former regime,which required isolation ofMRSA-positive patients,in preventing the spread of MRSA among residents in nursing homes. Method: This noninferioritycohort study used historical data on registered MRSA-cases in Norwegian nursing homes, information aboutinfection control measures in each nursing home,and statistics regarding the use of resources in primary health care. Results: The incidence rate for secondary cases of the same MRSA spa-type in the same nursing home was 6.3 per 1,000 person-years in nursing homes thatdid not isolateMRSA-infected residentsversus 18.5 per 1,000 person-years in nursing homes that did isolate such residents. The incidence rate ratio for new versus former MRSAregime was 0.34 (95% CI: 0.17–0.63). Conclusions: Thenonisolating MRSA regimeis equally effective as the isolatingregime in preventing the spread of MRSA. Our results suggest that allNorwegian nursing homes should implement the current national guidelines regarding MRSA / <p>978-91-86739-55-3</p>