Wenisch C, Laferl H, Szell M, Smolle K H, Grisold A, Bertha G, Krause R
Abteilung für Infektionen und Tropenmedizin, Kaiser-Franz-Josef-Spital, Kundratstrasse 3, 1100 Vienna, Austria.
Infection. 2006 Jun;34(3):148-54. doi: 10.1007/s15010-006-5107-7.
The number of Methicillin-resistant Staphylococcus aureus (MRSA) pneumonia cases is increasing in many European countries. In this observational study in one medical and three surgical ICUs multiple interventions for the treatment and eradication of nosocomial MRSA-pneumonia were used.
Twenty-one critically ill patients (age: 59 +/- 14 years, 15 males/6 females, 18 ventilator-associated, 3 nosocomial, clinical pulmonary infection score > 6 in all patients, APACHE II 18 +/- 5) were enrolled. The patients were treated with a 7-day course of iv linezolid (600 mg bid) plus rifampicin (600 mg bid), endotracheal vancomycin 100 mg qid, thrice daily mouth and throat washing with chlorhexidine 1% fluid and nasal mupirocin ointment, twice daily skin and hair washings with chlorhexidine gluconate 4% and tracheostomy (n = 8) wound care with povidone-iodine spray. Control samples (endotracheal secretions, nose, wound, and pharyngeal swabs) were taken 2, 3, 4, 7 days and 2 months thereafter. Multilobular pneumonia was seen in 16, pleural effusion in 12, and MRSA bacteremia in 4 patients.
One patient died during the follow-up period due to cerebral bleeding. In the remaining 20 patients, pneumonia was clinically cured in all patients and all patients were free of MRSA after eradication. Six patients died due to myocardial infarction (n = 3), gram-negative septic shock (n = 2), herpes encephalitis (n = 1) > 7 days after eradication. No MRSA reinfection occurred during the control period.
We conclude that in patients with MRSA pneumonia an approach using a 7-day course of intravenous linezolid plus rifampicin, intratracheal vancomycin, nasal mupirocin, cutaneous and oropharyngeal chlorhexidin plus povidone-iodine cures pneumonia and is effective for MRSA eradication.
在许多欧洲国家，耐甲氧西林金黄色葡萄球菌（MRSA）肺炎病例的数量正在增加。在这项针对一家内科重症监护病房和三家外科重症监护病房的观察性研究中，采用了多种干预措施来治疗和根除医院获得性MRSA肺炎。
纳入21例危重症患者（年龄：59±14岁，男15例/女6例，18例与呼吸机相关，3例为医院获得性，所有患者临床肺部感染评分>6，急性生理与慢性健康状况评分系统II 18±5）。患者接受为期7天的静脉注射利奈唑胺（600mg，每日两次）加 rifampicin（600mg，每日两次）治疗，气管内注射万古霉素100mg，每日四次，每日三次用1%氯己定液进行口腔和咽喉冲洗以及鼻腔使用莫匹罗星软膏，每日两次用4%葡萄糖酸氯己定进行皮肤和头发清洗，以及对气管切开术（n = 8）伤口用聚维酮碘喷雾剂进行护理。在第2、3、4、7天以及之后2个月采集对照样本（气管内分泌物、鼻腔、伤口和咽拭子）。16例患者出现多叶性肺炎，12例出现胸腔积液，4例出现MRSA菌血症。
1例患者在随访期间因脑出血死亡。在其余20例患者中，所有患者的肺炎均临床治愈，且所有患者在根除后均无MRSA感染。6例患者在根除后>7天因心肌梗死（n = 3）、革兰氏阴性菌败血症性休克（n = 2）、疱疹性脑炎（n = 1）死亡。在对照期间未发生MRSA再感染。
我们得出结论，对于MRSA肺炎患者，采用为期7天的静脉注射利奈唑胺加rifampicin、气管内注射万古霉素、鼻腔使用莫匹罗星、皮肤及口咽部使用氯己定加聚维酮碘的治疗方法可治愈肺炎且对根除MRSA有效。
