Directorate of Infection, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK.
J Antimicrob Chemother. 2011 Apr;66 Suppl 2:ii41-7. doi: 10.1093/jac/dkq325. Epub 2010 Sep 18.
The UK has seen a dramatic reduction in methicillin-resistant Staphylococcus aureus (MRSA) infection and transmission over the past few years in response to the mandatory MRSA bacteraemia surveillance scheme. Healthcare institutions have re-enforced basic infection control practice, such as universal hand hygiene, contact precautions and admission screening; however, the precipitous decline suggests other contributing factors. The intensive care unit (ICU), with its high endemic rates and complex patient population, is an important reservoir for seeding MRSA around the hospital and has understandably been at the forefront of MRSA control programmes. Recent studies from the UK and elsewhere have identified decolonization with agents such as chlorhexidine and mupirocin as having an important and perhaps underappreciated role in reducing ICU MRSA transmission, although evidence is incomplete and no prospective randomized studies have been performed. Chlorhexidine particularly is being recommended in the ICU for an increasing number of indications, including decolonization, universal patient bathing, oropharyngeal antisepsis in ventilated patients and vascular catheter insertion sites. Likewise, although there is little published evidence on decolonization efficacy or practice on UK general wards, it is now recommended for all MRSA-colonized patients and uptake is probably widespread. The recent observation that MRSA strains carrying the antiseptic resistance genes qacA/B can be clinically resistant to chlorhexidine raises a note of caution against its unfettered use. The dissemination of chlorhexidine-resistant MRSA would have implications for the decolonization of individual patients and for preventing transmission.
在过去的几年中，由于强制性耐甲氧西林金黄色葡萄球菌（MRSA）菌血症监测计划，英国的耐甲氧西林金黄色葡萄球菌（MRSA）感染和传播率显著下降。医疗机构加强了基本的感染控制措施，如普遍的手部卫生、接触预防和入院筛查；然而，急剧下降表明还有其他因素在起作用。重症监护病房（ICU）由于其高流行率和复杂的患者群体，是医院内 MRSA 传播的重要储库，并且理所当然地成为了 MRSA 控制计划的前沿。最近来自英国和其他地方的研究表明，使用洗必泰或莫匹罗星等药物进行去定植在降低 ICU-MRSA 传播方面具有重要作用，尽管证据不完整，也没有进行前瞻性随机研究。由于越来越多的原因，包括去定植、普遍的患者沐浴、接受机械通气患者的口腔消毒和血管导管插入部位的消毒，洗必泰在 ICU 中的使用得到了越来越多的推荐。同样，尽管关于英国普通病房去定植效果或实践的证据很少，但现在建议对所有 MRSA 定植患者进行去定植，并且接受程度可能很广泛。最近观察到，携带防腐剂耐药基因 qacA/B 的耐甲氧西林金黄色葡萄球菌菌株可能对洗必泰具有临床耐药性，这引起了对其无限制使用的警惕。洗必泰耐药性 MRSA 的传播将对个体患者的去定植和预防传播产生影响。
