Ammerlaan Heidi S M, Kluytmans Jan A J W, Wertheim Heiman F L, Nouwen Jan L, Bonten Marc J M
Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, The Netherlands.
Clin Infect Dis. 2009 Apr 1;48(7):922-30. doi: 10.1086/597291.
A systematic review was performed to determine the effectiveness of different approaches for eradicating methicillin-resistant Staphylococcus aureus carriage. Twenty-three clinical trials were selected that evaluated oral antibiotics (7 trials), topically applied antibiotics (12 trials), or both (4 trials). Because of clinical heterogeneity, quantitative analysis of all studies was deemed to be inappropriate, and exploratory subgroup analyses were performed for studies with similar study populations, methods, and targeted bacteria. The estimated pooled relative risk of treatment failure 1 week after short-term nasal mupirocin treatment, compared with placebo, was 0.10 (range, 0.07-0.14). There was low heterogeneity between study outcomes, and effects were similar for patients and healthy subjects, as well as in studies that included only methicillin-susceptible S. aureus carriers or both methicillin-susceptible S. aureus and methicillin-resistant S. aureus carriers. The development of drug resistance during treatment was reported in 1% and 9% of patients receiving mupirocin and oral antibiotics, respectively. Short-term nasal application of mupirocin is the most effective treatment for eradicating methicillin-resistant S. aureus carriage, with an estimated success of rate of 90% 1 week after treatment and approximately 60% after a longer follow-up period.
进行了一项系统评价，以确定不同方法根除耐甲氧西林金黄色葡萄球菌携带的有效性。选择了23项临床试验，这些试验评估了口服抗生素（7项试验）、局部应用抗生素（12项试验）或两者联合应用（4项试验）。由于临床异质性，认为对所有研究进行定量分析不合适，因此对具有相似研究人群、方法和目标细菌的研究进行了探索性亚组分析。与安慰剂相比，短期鼻腔应用莫匹罗星治疗1周后治疗失败的估计合并相对风险为0.10（范围为0.07-0.14）。研究结果之间的异质性较低，患者和健康受试者以及仅包括甲氧西林敏感金黄色葡萄球菌携带者或同时包括甲氧西林敏感金黄色葡萄球菌和耐甲氧西林金黄色葡萄球菌携带者的研究中效果相似。接受莫匹罗星和口服抗生素治疗的患者中，分别有1%和9%报告在治疗期间出现耐药性。短期鼻腔应用莫匹罗星是根除耐甲氧西林金黄色葡萄球菌携带的最有效治疗方法，治疗1周后估计成功率为90%，较长随访期后约为60%。
