Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York, New York, USA.
Laryngoscope. 2012 Oct;122(10):2125-31. doi: 10.1002/lary.23435. Epub 2012 Jul 9.
OBJECTIVES/HYPOTHESIS: Methicillin-resistant Staphylococcus aureus (MRSA) has been isolated from patients with acute rhinosinusitis (ARS) and chronic rhinosinusitis (CRS), although the exact prevalence is unknown. Similarly, the optimal treatment regimen for MRSA sinusitis has not been determined. The aim of this study was to summarize the existing data on prevalence and treatment outcomes for MRSA sinusitis in nonhospitalized patients.
A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
MEDLINE, Embase, and Cochrane databases were queried for English-language studies published between 1942 and 2012. Studies were excluded that did not provide quantitative data on the prevalence or treatment of ARS or CRS with MRSA-positive cultures. An itemized assessment of the risk of bias was conducted for each included study.
Of 409 studies identified during systematic review, 12 studies met the criteria for analysis. The level of evidence and freedom from bias of these studies were generally low. The prevalence of MRSA among all culture isolates ranged from 0% to 15.9% for ARS and 1.8% to 20.7% for CRS. Six studies reported quantitative treatment outcomes using variable measures, in which resolution of infection ranged from 58.3% to 100%. The treatment regimens were heterogeneous and included single- and multiple-agent therapy with oral, topical, and parental antibiotics.
MRSA-positive cultures are found in a small but significant number of cases of ARS and CRS. Treatment of MRSA sinusitis may be effective, although treatment regimens and outcome measures are variable. Prospective studies utilizing standardized parameters are warranted.
目的/假设：耐甲氧西林金黄色葡萄球菌（MRSA）已从急性鼻-鼻窦炎（ARS）和慢性鼻-鼻窦炎（CRS）患者中分离出来，尽管确切的流行率尚不清楚。同样，MRSA 鼻窦炎的最佳治疗方案也尚未确定。本研究旨在总结非住院患者中 MRSA 鼻窦炎的现有患病率和治疗结果数据。
根据系统评价和荟萃分析的首选报告项目进行了系统评价。
在 1942 年至 2012 年间，检索了 MEDLINE、Embase 和 Cochrane 数据库中以英文发表的研究。排除未提供关于耐甲氧西林金黄色葡萄球菌阳性培养物的 ARS 或 CRS 患病率或治疗的定量数据的研究。对每个纳入的研究进行了详细的偏倚评估。
在系统评价中确定了 409 项研究，其中 12 项研究符合分析标准。这些研究的证据水平和无偏倚程度普遍较低。所有培养物分离株中耐甲氧西林金黄色葡萄球菌的流行率，对于 ARS 为 0%至 15.9%，对于 CRS 为 1.8%至 20.7%。六项研究报告了使用不同措施的定量治疗结果，其中感染的解决率从 58.3%到 100%不等。治疗方案具有异质性，包括口服、局部和静脉用单药和多药治疗。
耐甲氧西林金黄色葡萄球菌阳性培养物在一小部分但具有重要意义的 ARS 和 CRS 病例中发现。MRSA 鼻窦炎的治疗可能有效，尽管治疗方案和结果衡量标准存在差异。需要进行前瞻性研究，使用标准化参数。
