Vivoni Adriana M, Santos Kátia R N, de-Oliveira Márcia P, Giambiagi-deMarval Marcia, Ferreira Adriana L P, Riley Lee W, Moreira Beatriz M
Instituto de Microbiologia Professor Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Infect Control Hosp Epidemiol. 2005 Jul;26(7):662-7. doi: 10.1086/502599.
From 1990 to 1995 at Hospital Universitário Clementino Fraga Filho, patients colonized or infected with methicillin-resistant Staphylococcus aureus (MRSA) were treated with mupirocin to eliminate MRSA carriage. In 1995, 65% of MRSA patients at this hospital had mupirocin-resistant isolates. Starting in 1996, mupirocin use was restricted to patients colonized, but not infected, with MRSA.
To describe the use of mupirocin for controlling MRSA over a decade and to analyze the molecular epidemiology of mupirocin-resistant MRSA infections at this hospital.
A 490-bed, tertiary-care university hospital.
The incidence densities of patients with MRSA and acquisition of mupirocin by the hospital were calculated for the period 1992-2001. S. aureus isolates from 1999-2000 were analyzed by pulsed-field gel electrophoresis. Mupirocin-resistant MRSA isolates from 1994-1995 and 1999-2000 were analyzed for ileS-2 gene background polymorphisms.
The incidence density of MRSA patients increased slightly over time, whereas the purchase of mupirocin decreased dramatically. Mupirocin-resistant MRSA infections decreased from 65% in 1994-1995 to 15% in 1999-2000. The MRSA Brazilian clone, detected in 1992, was still highly prevalent. The same ileS-2 encoding plasmid found in 1994-1995 persisted in three identical MRSA isolates from 1999-2000 belonging to the Brazilian clone.
After mupirocin use decreased, the ileS-2 encoding plasmid persisted in only a few Brazilian clone isolates. Our data on mupirocin-resistant MRSA incidence and mupirocin use strongly suggested that restricted use was related to decreased rates of mupirocin resistance at our hospital.
1990年至1995年期间，在克莱门蒂诺·弗拉加·菲略大学医院，对耐甲氧西林金黄色葡萄球菌（MRSA）定植或感染的患者使用莫匹罗星以消除MRSA携带情况。1995年，该医院65%的MRSA患者分离株对莫匹罗星耐药。从1996年开始，莫匹罗星的使用仅限于MRSA定植但未感染的患者。
描述十年来莫匹罗星在控制MRSA方面的使用情况，并分析该医院耐莫匹罗星MRSA感染的分子流行病学。
一家拥有490张床位的三级大学医院。
计算了1992年至2001年期间该医院MRSA患者的发病密度以及莫匹罗星的采购量。对1999年至2000年的金黄色葡萄球菌分离株进行脉冲场凝胶电泳分析。对1994年至1995年和1999年至2000年的耐莫匹罗星MRSA分离株进行ileS - 2基因背景多态性分析。
MRSA患者的发病密度随时间略有增加，而莫匹罗星采购量则大幅下降。耐莫匹罗星MRSA感染率从1994年至1995年的65%降至1999年至2000年的15%。1992年检测到的MRSA巴西克隆株仍然高度流行。在1994年至1995年发现的相同的ileS - 2编码质粒在1999年至2000年属于巴西克隆株的三个相同MRSA分离株中持续存在。
在莫匹罗星使用减少后，ileS - 2编码质粒仅在少数巴西克隆株分离株中持续存在。我们关于耐莫匹罗星MRSA发病率和莫匹罗星使用的数据强烈表明，限制使用与我院莫匹罗星耐药率降低有关。
