Infectious Diseases Service, Walter Reed National Military Medical Center, Bethesda, Maryland 20889, USA.
Infect Control Hosp Epidemiol. 2012 Aug;33(8):809-16. doi: 10.1086/666631. Epub 2012 Jun 11.
Methicillin-resistant Staphylococcus aureus (MRSA) pulsed-field type (PFT) USA300 causes skin and soft tissue infections in military recruits and invasive disease in hospitals. Chlorhexidine gluconate (CHG) is used to reduce MRSA colonization and infection. The impact of CHG on the molecular epidemiology of MRSA is not known.
To evaluate the impact of 2% CHG-impregnated cloths on the molecular epidemiology of MRSA colonization.
Cluster-randomized, double-blind, controlled trial.
Marine Officer Candidate School, Quantico, Virginia, in 2007.
Military recruits.
Thrice-weekly application of CHG-impregnated or control (Comfort Bath; Sage) cloths over the entire body.
Baseline and serial (every 2 weeks) nasal and/or axillary swab samples were assessed for MRSA colonization. Molecular analysis was performed with pulsed-field gel electrophoresis.
During training, 77 subjects (4.9%) acquired MRSA, 26 (3.3%) in the CHG group and 51 (6.5%) in the control group (P=.004). When analyzed for PFT, 24 subjects (3.1%) in the control group but only 6 subjects (0.8%) in the CHG group (P=.001) had USA300. Of the 167 colonizing isolates recovered from 77 subjects, 99 were recovered from the control group, including USA300 (40.4%), USA800 (38.4%), USA1000 (12.1%), and USA100 (6.1%), and 68 were recovered from the CHG group, including USA800 (51.5%), USA100 (23.5%), and USA300 (13.2%).
CHG decreased the transmission of MRSA--more specifically, USA300--among military recruits. In addition, USA300 and USA800 outcompeted other MRSA PFTs at incident colonization. Future studies should evaluate the broad-based use of CHG to decrease transmission of USA300 in hospital settings.
耐甲氧西林金黄色葡萄球菌（MRSA）脉冲场型（PFT）USA300 可引起新兵的皮肤和软组织感染以及医院的侵袭性疾病。葡萄糖酸洗必泰（CHG）用于减少 MRSA 的定植和感染。CHG 对 MRSA 定植的分子流行病学的影响尚不清楚。
评估 2%葡萄糖酸洗必泰浸渍布对 MRSA 定植的分子流行病学的影响。
集群随机、双盲、对照试验。
2007 年弗吉尼亚州匡蒂科的海军陆战队军官候补学校。
海军陆战队新兵。
每周三次应用 CHG 浸渍或对照（舒适浴；Sage）布擦拭全身。
对鼻和/或腋窝的基线和连续（每 2 周）拭子样本进行 MRSA 定植评估。使用脉冲场凝胶电泳进行分子分析。
在训练期间，77 名受试者（4.9%）获得了 MRSA，CHG 组 26 名（3.3%），对照组 51 名（6.5%）（P=0.004）。当按 PFT 进行分析时，对照组 24 名受试者（3.1%）而 CHG 组仅 6 名受试者（0.8%）（P=0.001）具有 USA300。从 77 名受试者中回收的 167 株定植分离株中，99 株来自对照组，包括 USA300（40.4%）、USA800（38.4%）、USA1000（12.1%）和 USA100（6.1%），68 株来自 CHG 组，包括 USA800（51.5%）、USA100（23.5%）和 USA300（13.2%）。
CHG 减少了 MRSA 的传播-更具体地说，是 USA300-在新兵中。此外，USA300 和 USA800 在新定植时比其他 MRSA PFT 更具竞争力。未来的研究应评估广泛使用 CHG 以减少医院环境中 USA300 的传播。
