Anesthesiology and Intensive Care Unit, Emergency Department, Hospital of Gorizia, Gorizia, Italy.
Minerva Anestesiol. 2010 Mar;76(3):193-202.
Topical vancomycin applied to the oropharynx has been shown to control carriage and lower airway infection due to methicillin-resistant Staphylococcus aureus (MRSA). We undertook a three-year prospective observational study to evaluate the effectiveness of two policies for topical vancomycin administration on oropharyngeal carriage and lower airway infection due to MRSA in patients requiring mechanical ventilation.
All consecutive patients aged over 18 years and expected to require mechanical ventilation for more than 72 hours were enrolled. During period one, patients who were established MRSA carriers received 1 g of 4% vancomycin gel into the oropharynx four times a day until carriage was abolished. During period two, all enrolled patients received the same protocol immediately on admission, irrespective of their MRSA carrier state.
One hundred ninety-one patients met the entry criteria (98 in period one and 93 in period two). During period one, 40 patients developed oropharyngeal MRSA carriage; of these, 29 acquired MRSA in the unit. In contrast, MRSA carriage was not demonstrated during period two (relative risk [RR] 0.018, 95% confidence interval [CI] 0-0.29; P=0.004). Twenty-one patients from period one suffered from an Intensive Care Unit-acquired lower airway infection due to MRSA, compared with five patients from period two (RR 0.25, 95% CI 0.10-0.64, P=0.004). Vancomycin-intermediate Staphylococcus aureus and vancomycin-resistant enterococci were not isolated.
In the setting of MRSA endemicity, the prevention of MRSA carriage by topical oropharyngeal vancomycin was more effective in reducing carriage and infection of the lower airways than treatment of established carriers.
局部万古霉素应用于口咽部已被证明可控制耐甲氧西林金黄色葡萄球菌（MRSA）引起的带菌和下呼吸道感染。我们进行了一项为期三年的前瞻性观察研究，以评估两种局部万古霉素给药政策对需要机械通气的患者口咽部 MRSA 定植和下呼吸道 MRSA 感染的有效性。
所有年龄超过 18 岁且预计需要机械通气超过 72 小时的连续患者均被纳入研究。在第一阶段，已确定为 MRSA 携带者的患者每天接受 1 克 4%万古霉素凝胶四次口腔内给药，直至定植被消除。在第二阶段，所有入组患者入院时立即接受相同方案，无论其是否为 MRSA 携带者。
191 名患者符合入选标准（第一阶段 98 例，第二阶段 93 例）。在第一阶段，40 名患者出现口咽部 MRSA 定植；其中 29 名在病房内获得 MRSA。相比之下，第二阶段未显示 MRSA 定植（相对风险 [RR] 0.018，95%置信区间 [CI] 0-0.29；P=0.004）。第一阶段有 21 名患者发生 ICU 获得性 MRSA 下呼吸道感染，而第二阶段有 5 名患者（RR 0.25，95% CI 0.10-0.64，P=0.004）。未分离到万古霉素中介金黄色葡萄球菌和万古霉素耐药肠球菌。
在 MRSA 流行地区，局部口咽部万古霉素预防 MRSA 定植比治疗已定植患者更能有效降低 MRSA 定植和下呼吸道感染。
