Horiuchi Akira, Nakayama Yoshiko, Kajiyama Masashi, Fujii Hideyasu, Tanaka Naoki
Departments of Gastroenterology and Pediatrics, Showa Inan General Hospital, Komagane, Japan.
Am J Gastroenterol. 2006 Feb;101(2):274-7. doi: 10.1111/j.1572-0241.2006.00366.x.
The aim of this study is to determine whether nasopharyngeal decolonization of methicillin-resistant Staphylococcus aureus (MRSA) can reduce peristomal wound infection shortly after percutaneous endoscopic gastrostomy (PEG) placement.
Of the 84 hospitalized patients referred for PEG, 72 were enrolled in a one-third observation (Group A) and two-thirds in a randomized trial (Groups B and C). Nasopharyngeal swabs were taken from a consecutive series of patients prior to PEG insertion. Based upon these results, they were classified into three groups: Group A, MRSA-negative (n = 24), Group B, MRSA-positive, but not eradicated (n = 24), Group C, MRSA-positive and eradicated with intranasal application of mupirocin, arbekacin inhalation, and oral sulfamethoxazole/trimethoprim (n = 24). The standard PEG pull-through insertion technique was performed on all 72 patients. All patients received prophylactic and concomitant antibiotics. Infections at the peristomal site were prospectively evaluated and defined as having at least two of the following conditions: peristomal erythema, induration, and purulent discharge. Bacterial culture using purulent discharge was performed.
There was significant difference in the peristomal infection rates among the groups: Group A, 0% (0/0); Group B, 100% (24/24); Group C, 8% (2/24) (p < or = 0.0001). In Group C, nasopharyngeal decolonization of MRSA, which was achieved by the combination of intranasal mupirocin, arbekacin inhalation, and oral sulfamethoxazole/trimethoprim in all 24 patients, significantly reduced peristomal infections. Eighteen (16 in Group B and 2 in Group C) of these 26 infected patients had cellulitis and developed purulent discharge from which MRSA was isolated.
Nasopharyngeal decolonization of MRSA can reduce peristomal infection shortly after the pull-through PEG insertion. MRSA appears to be a major pathogen in PEG peristomal infection while prophylactic and concomitant antibiotics are being used.
本研究旨在确定耐甲氧西林金黄色葡萄球菌（MRSA）的鼻咽部去定植是否能降低经皮内镜下胃造口术（PEG）置入后不久的造口周围伤口感染率。
在84例因PEG而住院的患者中，72例被纳入三分之一观察组（A组），三分之二被纳入随机试验组（B组和C组）。在PEG插入前，从一系列连续的患者中采集鼻咽拭子。根据这些结果，将他们分为三组：A组，MRSA阴性（n = 24）；B组，MRSA阳性但未根除（n = 24）；C组，MRSA阳性且通过鼻内应用莫匹罗星、吸入阿贝卡星和口服磺胺甲恶唑/甲氧苄啶根除（n = 24）。对所有72例患者均采用标准的PEG拖出式插入技术。所有患者均接受预防性和伴随性抗生素治疗。对造口周围部位的感染进行前瞻性评估，并定义为至少具备以下两种情况：造口周围红斑、硬结和脓性分泌物。对脓性分泌物进行细菌培养。
各组造口周围感染率存在显著差异：A组为0%（0/0）；B组为100%（24/24）；C组为8%（2/24）（p≤0.0001）。在C组中，通过鼻内莫匹罗星、吸入阿贝卡星和口服磺胺甲恶唑/甲氧苄啶联合使用，所有24例患者的MRSA鼻咽部去定植显著降低了造口周围感染。这26例感染患者中有18例（B组16例，C组2例）发生蜂窝织炎并出现脓性分泌物，从中分离出MRSA。
MRSA的鼻咽部去定植可降低PEG拖出式插入后不久的造口周围感染。在使用预防性和伴随性抗生素的情况下，MRSA似乎是PEG造口周围感染的主要病原体。
