Medical Intensive Care Department, Pontchaillou Hospital, Rennes 1 University, Rennes, France.
Infect Control Hosp Epidemiol. 2011 Nov;32(11):1064-72. doi: 10.1086/662180. Epub 2011 Sep 29.
To compare an interventional protocol with a standard protocol for preventing the acquisition of methicillin-resistant Staphylococcus aureus (MRSA) in the intensive care unit (ICU).
Prospective, randomized, controlled, parallel-group, nonblinded clinical trial.
Medical ICUs of 2 French university hospitals.
Five hundred adults with an expected length of stay in the ICU greater than 48 hours.
For the intervention group, the protocol required repeated MRSA screening, contact and droplet isolation precautions for patients at risk for MRSA at ICU admission and for MRSA-positive patients, and decontamination with nasal mupirocin and chlorhexidine body wash for MRSA-positive patients. For the standard group, the standard precautions protocol was used, and the results of repeated MRSA screening in the standard group were not communicated to investigators.
MRSA acquisition rate in the ICU. An audit was conducted to assess compliance with hygiene and isolation precautions.
In the intent-to-treat analysis ([Formula: see text]), the MRSA acquisition rate in the ICU was similar in the standard (13 [5.3%] of 243) and intervention (16 [6.5%] of 245) groups ([Formula: see text]). The audit showed that the overall compliance rate was 85.5% in the standard group and 84.1% in the intervention group ([Formula: see text]), although compliance was higher when isolation precautions were absent than when they were in place (88.2% vs 79.1%; [Formula: see text]). MRSA incidence rates were higher without isolation precautions (7.57‰) than with isolation precautions (2.36‰; [Formula: see text]).
Individual allocation to MRSA screening, isolation precautions, and decontamination do not provide individual benefit in reducing MRSA acquisition, compared with standard precautions, although the collective risk was lower during the periods of isolation.
Clinicaltrials.gov identifier: NCT00151606.
比较预防重症监护病房（ICU）获得耐甲氧西林金黄色葡萄球菌（MRSA）的介入性方案与标准方案。
前瞻性、随机、对照、平行组、非盲临床试验。
法国 2 所大学医院的内科 ICU。
500 名预计 ICU 住院时间超过 48 小时的成年人。
对于干预组，方案要求对 ICU 入院时存在 MRSA 风险的患者以及 MRSA 阳性患者进行反复 MRSA 筛查、接触和飞沫隔离预防措施，并对 MRSA 阳性患者进行鼻腔莫匹罗星和氯己定沐浴消毒。对于标准组，使用标准预防措施方案，并且标准组中重复的 MRSA 筛查结果不会传达给研究者。
ICU 中 MRSA 的获得率。进行审核以评估卫生和隔离预防措施的遵守情况。
意向治疗分析（[公式：见文本]）中，标准组（243 例中 13 例[5.3%]）和干预组（245 例中 16 例[6.5%]）ICU 中 MRSA 的获得率相似（[公式：见文本]）。审核显示，标准组的总体遵守率为 85.5%，干预组为 84.1%（[公式：见文本]），尽管在隔离措施不存在时的遵守率高于存在时（88.2%比 79.1%；[公式：见文本]）。没有隔离预防措施时的 MRSA 发病率（7.57‰）高于有隔离预防措施时（2.36‰；[公式：见文本]）。
与标准预防措施相比，将个体分配进行 MRSA 筛查、隔离预防措施和去污，并未在降低 MRSA 获得方面提供个体获益，尽管在隔离期间的总体风险较低。
Clinicaltrials.gov 标识符：NCT00151606。
