Harbarth S, Dharan S, Liassine N, Herrault P, Auckenthaler R, Pittet D
Infection Control Program, University Hospitals of Geneva, CH-1211 Geneva 14, Switzerland.
Antimicrob Agents Chemother. 1999 Jun;43(6):1412-6. doi: 10.1128/AAC.43.6.1412.
Mupirocin has been widely used for the clearance of nasal methicillin-resistant Staphylococcus aureus (MRSA) carriage during outbreaks, but no placebo-controlled trial has evaluated its value for eradicating MRSA carriage at multiple body sites in settings where MRSA is not epidemic. In a 1,500-bed teaching hospital with endemic MRSA, 102 patients colonized with MRSA were randomized into a double-blind, placebo-controlled trial and treated with either mupirocin (group M) or placebo (group P) applied to the anterior nares for 5 days; both groups used chlorhexidine soap for body washing. Follow-up screening, susceptibility testing, and genotyping were performed to evaluate treatment success, mupirocin or chlorhexidine resistance, and exogenous recolonization. At baseline, MRSA carriage was 60% in the nares, 38% in the groin, and 62% in other sites (skin lesions, urine). The MRSA eradication rate (all body sites) was 25% in group M (12 of 48 patients), compared to 18% in group P (9 of 50 patients; relative risk [RR], 0.72; 95% confidence interval [CI95], 0.33 to 1.55). At the end of follow-up, 44% of patients (19 of 43) were free of nasal MRSA in group M, compared to 23% (11 of 44) in group P (RR, 0.57; CI95, 0.31 to 1.04). Ten patients developed MRSA infections (three in group M and seven in group P). One mupirocin treatment failure was due to exogenous MRSA recolonization. No MRSA isolate showed chlorhexidine resistance or high-level mupirocin resistance; however, we observed an association (P = 0.003) between low-level mupirocin resistance at study entry (prevalence, 23%) and subsequent treatment failure in both study arms. These results suggest that nasal mupirocin is only marginally effective in the eradication of multisite MRSA carriage in a setting where MRSA is endemic.
莫匹罗星已被广泛用于在疫情爆发期间清除鼻腔耐甲氧西林金黄色葡萄球菌（MRSA）携带，但尚无安慰剂对照试验评估其在MRSA非流行环境中根除多个身体部位MRSA携带的价值。在一家拥有1500张床位且MRSA呈地方性流行的教学医院中，102例MRSA定植患者被随机纳入一项双盲、安慰剂对照试验，分别接受莫匹罗星（M组）或安慰剂（P组）治疗，将药物涂抹于前鼻孔，持续5天；两组均使用洗必泰肥皂进行全身清洗。进行随访筛查、药敏试验和基因分型，以评估治疗效果、莫匹罗星或洗必泰耐药性以及外源性再定植情况。在基线时，鼻腔MRSA携带率为60%，腹股沟为38%，其他部位（皮肤病变、尿液）为62%。M组（48例患者中的12例）的MRSA根除率（所有身体部位）为25%，而P组（50例患者中的9例）为18%（相对风险[RR]，0.72；95%置信区间[CI95]，0.33至1.55）。在随访结束时，M组44%（43例中的19例）的患者鼻腔无MRSA，而P组为23%（44例中的11例）（RR，0.57；CI95，0.31至1.04）。10例患者发生了MRSA感染（M组3例，P组7例）。1例莫匹罗星治疗失败是由于外源性MRSA再定植。没有MRSA分离株显示对洗必泰耐药或对莫匹罗星高水平耐药；然而，我们观察到研究开始时低水平莫匹罗星耐药（患病率，23%）与两个研究组随后的治疗失败之间存在关联（P = 0.003）。这些结果表明，在MRSA呈地方性流行的环境中，鼻腔使用莫匹罗星在根除多部位MRSA携带方面仅具有微弱的效果。
