Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands.
N Engl J Med. 2010 Jan 7;362(1):9-17. doi: 10.1056/NEJMoa0808939.
Nasal carriers of Staphylococcus aureus are at increased risk for health care-associated infections with this organism. Decolonization of nasal and extranasal sites on hospital admission may reduce this risk.
In a randomized, double-blind, placebo-controlled, multicenter trial, we assessed whether rapid identification of S. aureus nasal carriers by means of a real-time polymerase-chain-reaction (PCR) assay, followed by treatment with mupirocin nasal ointment and chlorhexidine soap, reduces the risk of hospital-associated S. aureus infection.
From October 2005 through June 2007, a total of 6771 patients were screened on admission. A total of 1270 nasal swabs from 1251 patients were positive for S. aureus. We enrolled 917 of these patients in the intention-to-treat analysis, of whom 808 (88.1%) underwent a surgical procedure. All the S. aureus strains identified on PCR assay were susceptible to methicillin and mupirocin. The rate of S. aureus infection was 3.4% (17 of 504 patients) in the mupirocin-chlorhexidine group, as compared with 7.7% (32 of 413 patients) in the placebo group (relative risk of infection, 0.42; 95% confidence interval [CI], 0.23 to 0.75). The effect of mupirocin-chlorhexidine treatment was most pronounced for deep surgical-site infections (relative risk, 0.21; 95% CI, 0.07 to 0.62). There was no significant difference in all-cause in-hospital mortality between the two groups. The time to the onset of nosocomial infection was shorter in the placebo group than in the mupirocin-chlorhexidine group (P=0.005).
The number of surgical-site S. aureus infections acquired in the hospital can be reduced by rapid screening and decolonizing of nasal carriers of S. aureus on admission. (Current Controlled Trials number, ISRCTN56186788.)
金黄色葡萄球菌鼻腔携带者发生与这种病原体相关的医源性感染的风险增加。入院时对鼻腔和鼻腔外部位进行去定植可能会降低这种风险。
在一项随机、双盲、安慰剂对照、多中心试验中，我们评估了通过实时聚合酶链反应（PCR）检测快速识别金黄色葡萄球菌鼻腔携带者，然后使用莫匹罗星鼻软膏和洗必泰肥皂进行治疗，是否可以降低医院获得性金黄色葡萄球菌感染的风险。
2005 年 10 月至 2007 年 6 月，共对 6771 例入院患者进行了筛查。共有 1251 例患者的 1270 份鼻腔拭子对金黄色葡萄球菌呈阳性。我们对其中 917 例患者进行了意向治疗分析，其中 808 例（88.1%）接受了手术。所有通过 PCR 检测鉴定的金黄色葡萄球菌菌株对甲氧西林和莫匹罗星均敏感。莫匹罗星-洗必泰组金黄色葡萄球菌感染率为 3.4%（504 例患者中有 17 例），安慰剂组为 7.7%（413 例患者中有 32 例）（感染相对风险，0.42；95%置信区间[CI]，0.23 至 0.75）。莫匹罗星-洗必泰治疗的效果对于深部手术部位感染最为明显（相对风险，0.21；95%CI，0.07 至 0.62）。两组之间的全因院内死亡率无显著差异。安慰剂组的医院感染发病时间短于莫匹罗星-洗必泰组（P=0.005）。
入院时快速筛查和去定植金黄色葡萄球菌鼻腔携带者可以减少医院获得性手术部位金黄色葡萄球菌感染的数量。（当前对照试验编号，ISRCTN56186788。）
