Lennox Hill Hospital, New York, NY, USA.
Am J Otolaryngol. 2012 Sep-Oct;33(5):572-5. doi: 10.1016/j.amjoto.2012.02.002. Epub 2012 Apr 12.
Methicillin-sensitive Staphylococcus aureus (MSSA) and methicillin-resistant S aureus (MRSA) contribute to 25% of nosocomial infections, increasing complications, health care cost, and growing antibiotic resistance. Nasal decolonization (ND) can reduce the staphylococcal infection rate. A new method of laser therapy (LT) MRSA ND was tested.
This is a prospective, nonrandomized study.
Following institutional review board approvals, 25 patients colonized with MSSA/MRSA were allocated to 4 treatment arms; low-power, dual-wavelength 870-/930-nm laser alone (GR1); low-power, dual-wavelength laser followed by erythromycin (E-mycin) cream (GR2); low-power, dual-wavelength laser followed by peroxide irrigation (GR3); and high-power 940-nm laser alone (GR4). Quantitative cultures were obtained before and after in all arms. Laser therapy was performed via a laser fiber diffuser, delivering 200 to 600 J/cm² to each naris circumferentially. Patient's distribution was 3 in GR1, 14 in GR2, 4 in GR3, and 4 in GR4 (last 10 recruited to GR4).
Nasal decolonization for GR1, GR2, GR3, and GR4 was 1 of 3, 13 of 14, 2 of 4, and 4 of 4, respectively. Because LT + E-mycin cleared all first 3 patients of MRSA and MSSA, all remaining patients were treated with LT + Er with over 90% of patients clearing. No adverse events or discomfort were reported.
First human study using LT and topical E-mycin in ND is presented. Laser therapy can eradicate MRSA and potentially resensitization of bacteria to the antimicrobial effect of erythromycin. Although decolonization was maintained at 4 weeks posttreatment, further studies can determine the LT long-term effect.
耐甲氧西林金黄色葡萄球菌（MSSA）和耐甲氧西林金黄色葡萄球菌（MRSA）导致 25%的医院感染，增加了并发症、医疗保健成本和不断增加的抗生素耐药性。鼻腔去定植（ND）可以降低葡萄球菌感染率。测试了一种新的激光治疗（LT）MRSA ND 方法。
这是一项前瞻性、非随机研究。
在获得机构审查委员会批准后，将 25 名定植了 MSSA/MRSA 的患者分配到 4 个治疗组；低功率、双波长 870-/930nm 激光单独使用（GR1）；低功率、双波长激光联合红霉素（E-mycin）乳膏（GR2）；低功率、双波长激光联合过氧化物冲洗（GR3）；和高功率 940nm 激光单独使用（GR4）。所有组均在治疗前后进行定量培养。激光治疗通过激光纤维扩散器进行，每个鼻孔圆周向递送 200 至 600J/cm²。患者分布为 GR1 组 3 例，GR2 组 14 例，GR3 组 4 例，GR4 组 4 例（最后 10 例招募至 GR4 组）。
GR1、GR2、GR3 和 GR4 的鼻腔去定植率分别为 1/3、13/14、2/4 和 4/4。由于 LT+E-mycin 清除了前 3 例患者的所有 MRSA 和 MSSA，所有剩余患者均接受 LT+Er 治疗，超过 90%的患者清除。没有报告不良事件或不适。
首次提出了使用 LT 和局部红霉素进行 ND 的人体研究。激光治疗可以根除 MRSA，并可能使细菌重新对红霉素的抗菌作用敏感。尽管治疗后 4 周仍保持去定植，但进一步的研究可以确定 LT 的长期效果。
