NorthShore University HealthSystem, Evanston, Illinois 60201, USA.
Surg Infect (Larchmt). 2013 Feb;14(1):69-72. doi: 10.1089/sur.2012.086. Epub 2013 Feb 28.
Mupirocin nasal ointment may be prescribed for decolonization prior to surgical procedures, especially for carriers of methicillin-resistant Staphylococcus aureus (MRSA). The approved regimen for decolonization of S. aureus from the anterior nares is twice daily for 5 d (10 doses). We performed a two-center, randomized, open-label study to compare the utility of six and 10 doses for decolonization of S. aureus.
Patients expecting to undergo surgery were screened for S. aureus nasal carriage approximately three weeks prior to the procedure. Those found to be positive were offered enrollment in the study. In the first arm (n=41), patients were randomized to receive 2, 3, or 5 d (six or 10 doses) of treatment prior to their operation. Their anterior nares were swabbed for culture and S. aureus polymerase chain reaction (PCR) during the decolonization therapy period as well as for four weeks after surgery. In the second arm (n=60), all patients were given 5 d (10 doses) of nasal mupirocin treatment, and the patient's anterior nares were swabbed for culture and S. aureus PCR for four weeks after surgery. Data from six of the patients were excluded from analysis because of failure to submit swabs after operation. All S. aureus isolates were tested for susceptibility to mupirocin and the presence of the mecA gene to detect MRSA.
In Arm 1, 16 patients received 10 doses of mupirocin, 18 received six doses (twice daily for 3 d), and 7 received six doses (thrice daily for 2 d). In the second arm, all patients received 10 doses of mupirocin (twice a day for 5 d). Overall, 89.5% patients who received 10 doses of mupirocin remained decolonized for at least four weeks after surgery versus 68.0% of patients who received six doses (p=0.016). There was no difference between arms 1 and 2 for those given mupirocin twice daily for 5 d.
The ten-dose regimen is superior to any six-dose regimen for de-colonizing S. aureus from the anterior nares of patients and for maintaining the decolonized state for at least four weeks after therapy.
莫匹罗星鼻软膏可在手术前用于去定植，特别是对于耐甲氧西林金黄色葡萄球菌（MRSA）携带者。去定植金黄色葡萄球菌鼻腔的批准方案是每天两次，持续 5 天（10 剂）。我们进行了一项两中心、随机、开放标签研究，比较了 6 剂和 10 剂用于去定植金黄色葡萄球菌的效果。
预计接受手术的患者在手术前大约三周接受金黄色葡萄球菌鼻腔携带情况的筛查。发现阳性者可参加该研究。在第一组（n=41）中，患者随机接受 2、3 或 5 天（6 或 10 剂）治疗，然后再进行手术。在去定植治疗期间以及手术后四周，他们的前鼻腔进行了拭子培养和金黄色葡萄球菌聚合酶链反应（PCR）检测。在第二组（n=60）中，所有患者均接受 5 天（10 剂）莫匹罗星鼻腔治疗，手术后四周对患者的前鼻腔进行了拭子培养和金黄色葡萄球菌 PCR 检测。由于术后未能提交拭子，有 6 名患者的数据被排除在分析之外。所有金黄色葡萄球菌分离株均进行了药敏试验和 mecA 基因检测，以检测耐甲氧西林金黄色葡萄球菌。
在第一组中，16 名患者接受了 10 剂莫匹罗星，18 名患者接受了 6 剂（每天两次，持续 3 天），7 名患者接受了 6 剂（每天三次，持续 2 天）。在第二组中，所有患者均接受了 10 剂莫匹罗星（每天两次，持续 5 天）。总的来说，接受 10 剂莫匹罗星治疗的患者中有 89.5%在术后至少四周保持去定植状态，而接受 6 剂治疗的患者中有 68.0%（p=0.016）。对于接受莫匹罗星每天两次、持续 5 天治疗的两组患者，无差异。
对于金黄色葡萄球菌鼻腔去定植和术后至少 4 周保持去定植状态，10 剂方案优于任何 6 剂方案。
