聚维酮碘湿巾预防海军新兵皮肤软组织感染的效果：一项集群随机、双盲、对照有效性试验。
Chlorhexidine-impregnated cloths to prevent skin and soft-tissue infection in Marine recruits: a cluster-randomized, double-blind, controlled effectiveness trial.
机构信息
Division of Infectious Diseases, Department of Internal Medicine, National Naval Medical Center, Bethesda, Maryland, USA.
出版信息
Infect Control Hosp Epidemiol. 2010 Dec;31(12):1207-15. doi: 10.1086/657136. Epub 2010 Oct 28.
BACKGROUND
Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) causes skin and soft-tissue infection (SSTI) in military recruits.
OBJECTIVE
To evaluate the effectiveness of 2% chlorhexidine gluconate (CHG)-impregnated cloths in reducing rates of SSTI and S. aureus colonization among military recruits.
DESIGN
A cluster-randomized (by platoon), double-blind, controlled effectiveness trial.
SETTING
Marine Officer Candidate School, Quantico, Virginia, 2007.
PARTICIPANTS
Military recruits.
INTERVENTION
Application of CHG-impregnated or control (Comfort Bath; Sage) cloths applied over entire body thrice weekly.
MEASUREMENTS
Recruits were monitored daily for SSTI. Baseline and serial nasal and/or axillary swabs were collected to assess S. aureus colonization.
RESULTS
Of 1,562 subjects enrolled, 781 (from 23 platoons) underwent CHG-impregnated cloth application and 781 (from 21 platoons) underwent control cloth application. The rate of compliance (defined as application of 50% or more of wipes) at 2 weeks was similar (CHG group, 63%; control group, 67%) and decreased over the 6-week period. The mean 6-week SSTI rate in the CHG-impregnated cloth group was 0.094, compared with 0.071 in the control group (analysis of variance model rate difference, 0.025 ± 0.016; P = .14). At baseline, 43% of subjects were colonized with methicillin-susceptible S. aureus (MSSA), and 2.1% were colonized with MRSA. The mean incidence of colonization with MSSA was 50% and 61% (P = .026) and with MRSA was 2.6% and 6.0% (P = .034) for the CHG-impregnated and control cloth groups, respectively.
CONCLUSIONS
CHG-impregnated cloths applied thrice weekly did not reduce rates of SSTI among recruits. S. aureus colonization rates increased in both groups but to a lesser extent in those assigned to the CHG-impregnated cloth intervention. Antecedent S. aureus colonization was not a risk factor for SSTI. Additional studies are needed to identify effective measures for preventing SSTI among military recruits.
CLINICAL TRIALS REGISTRATION
ClinicalTrials.gov identifier: NCT00475930.
背景
社区相关性耐甲氧西林金黄色葡萄球菌（CA-MRSA）可导致新兵发生皮肤和软组织感染（SSTI）。
目的
评估 2%葡萄糖酸氯己定（CHG）浸渍布在降低新兵 SSTI 和金黄色葡萄球菌定植率方面的效果。
设计
簇随机（按排）、双盲、对照效果试验。
地点
弗吉尼亚州匡提科的海军陆战队军官候补学校，2007 年。
参与者
新兵。
干预措施
每周三次全身涂抹 CHG 浸渍布或对照（舒适浴；Sage）布。
测量
新兵每天监测 SSTI。采集基线和连续的鼻拭子和/或腋窝拭子，以评估金黄色葡萄球菌定植情况。
结果
1562 名受试者中，781 名（来自 23 个排）接受了 CHG 浸渍布应用，781 名（来自 21 个排）接受了对照布应用。第 2 周的依从率（定义为应用 50%或更多拭子）相似（CHG 组为 63%；对照组为 67%），并在 6 周期间逐渐下降。CHG 浸渍布组的平均 6 周 SSTI 发生率为 0.094，而对照组为 0.071（方差分析模型率差，0.025±0.016；P = 0.14）。基线时，43%的受试者定植了甲氧西林敏感金黄色葡萄球菌（MSSA），2.1%定植了耐甲氧西林金黄色葡萄球菌（MRSA）。CHG 浸渍布组 MSSA 的平均发病率为 50%和 61%（P = 0.026），MRSA 的发病率为 2.6%和 6.0%（P = 0.034），对照组分别为。
结论
每周三次全身涂抹 CHG 布并不能降低新兵的 SSTI 发生率。两组金黄色葡萄球菌定植率均有所增加，但 CHG 浸渍布干预组的增加幅度较小。先前的金黄色葡萄球菌定植不是 SSTI 的危险因素。需要进一步的研究来确定预防军事新兵 SSTI 的有效措施。
临床试验注册
ClinicalTrials.gov 标识符：NCT00475930。
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