Harbarth S, Liassine N, Dharan S, Herrault P, Auckenthaler R, Pittet D
Infection Control Program, University Hospitals of Geneva, Geneva, Switzerland.
Clin Infect Dis. 2000 Dec;31(6):1380-5. doi: 10.1086/317484. Epub 2000 Nov 10.
We determined risk factors associated with persistent carriage of methicillin-resistant Staphylococcus aureus (MRSA) among 102 patients enrolled in a double-blind, placebo-controlled trial of nasally administered mupirocin ointment. MRSA decolonization was unsuccessful in 77 (79%) of 98 patients who met the criteria for evaluation. By univariate analysis, 4 variables were found to be associated with persistent MRSA colonization (P < .1 for all 4): absence of mupirocin treatment, previous fluoroquinolone therapy, > or = 2 MRSA-positive body sites, and low-level mupirocin resistance. After multivariable Cox proportional hazards modeling, the presence of > or = 2 positive body sites (adjusted hazard ratio [AHR], 1.7; 95% confidence interval [CI], 1.0-2.9) and previous receipt of a fluoroquinolone (AHR, 1.8; 95% CI, 1.0-3.3) were independently associated with MRSA persistence, whereas nasal mupirocin tended to confer protection (AHR, 0.6; 95% CI, 0.4-1.0). Low-level mupirocin resistance was observed in 9 genotypically different MRSA strains and was not independently associated with chronic MRSA carriage (AHR, 1.5; 95% CI, 0.9-2.5). Our findings suggest that multisite MRSA carriage and previous receipt of a fluoroquinolone are independent risk factors for persistent MRSA colonization.
我们在一项关于鼻用莫匹罗星软膏的双盲、安慰剂对照试验的102例患者中，确定了与耐甲氧西林金黄色葡萄球菌（MRSA）持续携带相关的风险因素。在符合评估标准的98例患者中，77例（79%）的MRSA去定植未成功。单因素分析发现，有4个变量与MRSA持续定植相关（所有4个变量的P均<0.1）：未接受莫匹罗星治疗、既往接受氟喹诺酮治疗、≥2个MRSA阳性身体部位以及低水平莫匹罗星耐药。多变量Cox比例风险模型分析后，≥2个阳性身体部位的存在（调整后风险比[AHR]，1.7；95%置信区间[CI]，1.0 - 2.9）和既往接受氟喹诺酮治疗（AHR，1.8；95%CI，1.0 - 3.3）与MRSA持续存在独立相关，而鼻用莫匹罗星倾向于提供保护作用（AHR，0.6；95%CI，0.4 - 1.0）。在9种基因型不同的MRSA菌株中观察到低水平莫匹罗星耐药，且其与慢性MRSA携带无独立相关性（AHR，1.5；95%CI，0.9 - 2.5）。我们的研究结果表明，多部位MRSA携带和既往接受氟喹诺酮治疗是MRSA持续定植的独立风险因素。
