Cerdá Enrique, Abella Ana, de la Cal Miguel A, Lorente José A, García-Hierro Paloma, van Saene Hendrick K F, Alía Inmaculada, Aranguren Ainhoa
Department of Critical Care Medicine, Hospital Universitario de Getafe, Madrid, Spain.
Ann Surg. 2007 Mar;245(3):397-407. doi: 10.1097/01.sla.0000250418.14359.31.
The aim of this study was to assess the efficacy and safety of enteral vancomycin in controlling MRSA endemicity in an intensive care burn unit.
MRSA is a serious clinical and epidemiologic problem. It is not uncommon that the traditional maneuvers, detection and isolation of carriers, fail to control endemicity due to MRSA.
All patients admitted to an Intensive Care Burn unit from January 1995 to February 2004 have been included in this prospective cohort study comprised 2 different periods. During period 1 (January 1995 to January 2000), barrier and isolation measures were enforced. During period 2 (February 2000 to February 2004), patients received enteral vancomycin 4 times daily in addition to selective digestive decontamination.
A total of 777 patients were enrolled into the study: 402 in period 1, and 375 in period 2. There were no significant differences in the characteristics of patients between the 2 periods, except for the total body surface burned area, 30.3% in period 1 and 25.61% in period 2 (P = 0.009). There was a significant reduction in the incidence of patients who acquired MRSA from 115 in period 1 to 25 in period 2 (RR, 0.22; 95% confidence interval [CI], 0.15-0.34). Similar reductions were observed in the number of patients with wound (RR, 0.20; 95% CI, 0.12-0.32), blood (RR, 0.13; 95% CI, 0.04-0.35), and tracheal aspirate (RR, 0.07; 95% CI, 0.03-0.19), samples positive for MRSA. There was no emergence of either vancomycin-resistant enterococci or Staphylococcus aureus with intermediate sensitivity to glycopeptides in period 2.
Enteral vancomycin is an effective and safe method to control MRSA in intensive care burn units without VRE.
本研究旨在评估肠内应用万古霉素在控制重症烧伤监护病房耐甲氧西林金黄色葡萄球菌（MRSA）流行方面的有效性和安全性。
MRSA是一个严重的临床和流行病学问题。传统措施，即检测和隔离携带者，因MRSA而未能控制其流行的情况并不少见。
1995年1月至2004年2月入住重症烧伤监护病房的所有患者均纳入这项前瞻性队列研究，该研究包括2个不同时期。在第1期（1995年1月至2000年1月），实施了屏障和隔离措施。在第2期（2000年2月至2004年2月），患者除接受选择性消化道去污外，还每日4次接受肠内万古霉素治疗。
共有777例患者纳入研究：第1期402例，第2期375例。除烧伤总面积外，两期患者特征无显著差异，第1期为30.3%，第2期为25.61%（P = 0.009）。获得MRSA的患者发生率从第1期的115例显著降至第2期的25例（相对危险度，0.22；95%置信区间[CI]，0.15 - 0.34）。在伤口（相对危险度，0.20；95% CI，0.12 - 0.32）、血液（相对危险度，0.13；95% CI，0.04 - 0.35）和气管吸出物（相对危险度，0.07；95% CI，0.03 - 0.19）样本中MRSA呈阳性的患者数量也有类似减少。第2期未出现耐万古霉素肠球菌或对糖肽类药物中度敏感的金黄色葡萄球菌。
肠内应用万古霉素是控制无耐万古霉素肠球菌的重症烧伤监护病房中MRSA的一种有效且安全的方法。
