莫匹罗星在腹膜透析导管出口处的常规使用及莫匹罗星耐药性：7年后仍处于低水平

Routine use of mupirocin at the peritoneal catheter exit site and mupirocin resistance: still low after 7 years.

作者信息

Lobbedez Thierry, Gardam Michael, Dedier Helen, Burdzy Dorothy, Chu Maggie, Izatt Sharon, Bargman Joanne M, Jassal Sarbjit V, Vas Stephen, Brunton James, Oreopoulos Dimitrios G

机构信息

Division of Nephrology, University Health Network, Toronto, Canada.

出版信息

Nephrol Dial Transplant. 2004 Dec;19(12):3140-3. doi: 10.1093/ndt/gfh494. Epub 2004 Oct 5.

DOI:10.1093/ndt/gfh494

PMID:15466881

Abstract

OBJECTIVE

The purpose of this study (the third in a series of similar studies) is to evaluate the prevalence of Staphylococcus aureus (SA), methicillin-resistant SA (MRSA) and mupirocin-resistant SA (MuRSA) carriers in a peritoneal dialysis centre where patients have been instructed to use prophylactic mupirocin ointment at the catheter exit site over the last 7 years.

METHODS

Swabs were taken from catheter exit site, nares, axillae and groin in 147 chronic peritoneal dialysis out-patients between November 2003 and January 2004. Axillae/groin and nasal samples were pooled and cultured in the same medium, whereas exit site swabs were cultured separately. All SA isolated were tested for methicillin and mupirocin resistance using oxacillin screening plates and E-test strips.

RESULTS

Sixteen of 147 patients (10.9%) were found to be SA carriers: of these 13 (8.8%) had a positive nasal/axillae/groin culture; two (1.4%) had both nasal/axillae/groin- and exit site-positive culture; and one (0.7%) had only exit site-positive culture. In these 16 SA carriers, we found mupirocin-resistant strains (MuRSA) in four patients (25%) and MRSA in two patients (12.5%). Among the four MuRSA carriers, one had both nasal/axillae/groin- and exit site-positive culture and three had only nasal/axillae/groin-positive culture. Three high-level resistance and one low-level resistance MuRSA carriers were isolated. One MuRSA strain was also methicillin resistant. All MRSA strains were sensitive to vancomycin and rifampicin.

CONCLUSION

After 7 years' routine use of prophylactic mupirocin ointment at the catheter exit site in non-selected chronic peritoneal dialysis patients, MuRSA was found in 25% of SA strains isolated or in 2.7% of the patients. Compared with our previous study, 3 years earlier, there is no significant increase in the MuRSA prevalence in peritoneal dialysis patients who routinely apply mupirocin ointment at the catheter exit site.

摘要

目的

本研究（一系列类似研究中的第三项）旨在评估一家腹膜透析中心金黄色葡萄球菌（SA）、耐甲氧西林金黄色葡萄球菌（MRSA）和耐莫匹罗星金黄色葡萄球菌（MuRSA）携带者的患病率，在过去7年里，该中心的患者一直被指导在导管出口处使用预防性莫匹罗星软膏。

方法

2003年11月至2004年1月期间，对147例慢性腹膜透析门诊患者的导管出口处、鼻孔、腋窝和腹股沟进行拭子采样。腋窝/腹股沟和鼻腔样本合并后在同一培养基中培养，而出口处拭子单独培养。所有分离出的SA均使用苯唑西林筛选平板和E-test试纸条检测对甲氧西林和莫匹罗星的耐药性。

结果

147例患者中有16例（10.9%）被发现为SA携带者：其中13例（8.8%）鼻腔/腋窝/腹股沟培养阳性；2例（1.4%）鼻腔/腋窝/腹股沟和出口处培养均为阳性；1例（0.7%）仅出口处培养阳性。在这16例SA携带者中，我们发现4例患者（25%）有耐莫匹罗星菌株（MuRSA），2例患者（12.5%）有MRSA。在4例MuRSA携带者中，1例鼻腔/腋窝/腹股沟和出口处培养均为阳性，3例仅鼻腔/腋窝/腹股沟培养阳性。分离出3例高水平耐药和1例低水平耐药的MuRSA携带者。1株MuRSA菌株也耐甲氧西林。所有MRSA菌株对万古霉素和利福平敏感。