Davido Benjamin, Dinh Aurélien, Salomon Jérôme, Roux Anne Laure, Gosset-Woimant Marine, Pierre Isabelle, Perronne Christian, Bernard Louis
From the Infectious Diseases Department, Raymond Poincaré Hospital, Paris Ile-de-France Ouest University , Garches.
Scand J Infect Dis. 2013 Nov;45(11):837-41. doi: 10.3109/00365548.2013.810815. Epub 2013 Jul 15.
The treatment of recurrent furunculosis is poorly documented and represents a public health challenge. The medical care of this disease is often disappointing, especially as the disease evolution is uncertain and relapses occur. We report the efficacy and safety of our CMC regimen: skin disinfection (chlorhexidine), local nasal antibiotic (mupirocin), and systemic antibiotic (clindamycin).
Patients attending our institution during the period 2006-2012 for recurrent furunculosis (≥ 4 episodes/y) were enrolled in the study. Clinical and bacteriological data were collected. Staphylococcus aureus colonization was also investigated in close contacts, and carriers were treated. Patients were treated with the CMC regimen: skin disinfection with chlorhexidine for 21 days, nasal mupirocin ointment for 5 days, and oral clindamycin 1800-2400 mg for 21 days.
Nineteen patients were included. Their mean age was 36 ± 14.5 y and the male to female sex ratio was 1.1. Screening swabs from all sites were S. aureus-positive in 63% (n = 12), including 4 methicillin-resistant S. aureus (MRSA). Before the CMC regimen, the median time to relapse was 31 days (mean 52 days). The mean number of recurrences was 5.5 ± 2.4/y. After the CMC regimen, among 16 patients who had a complete follow-up, 14 were healed beyond 9 months. Two recurrences occurred, 1 in an MRSA carrier and 1 in a patient with an insufficiently treated dermatosis. No serious side effect occurred that required the cessation of treatment.
There are 2 major routes involved in recurrent furunculosis: risk factors and staphylococcal colonization of close contacts. Our procedure is safe and effective, with 87% remission beyond 9 months. It merits testing on larger numbers of participants.
复发性疖病的治疗记录较少，是一项公共卫生挑战。该疾病的医疗护理往往令人失望，尤其是因为疾病进展不确定且会复发。我们报告了我们的CMC方案的疗效和安全性：皮肤消毒（氯己定）、局部鼻腔抗生素（莫匹罗星）和全身抗生素（克林霉素）。
纳入2006年至2012年期间因复发性疖病（每年≥4次发作）到我们机构就诊的患者。收集临床和细菌学数据。还对密切接触者进行金黄色葡萄球菌定植调查，并对携带者进行治疗。患者接受CMC方案治疗：用氯己定进行皮肤消毒21天，鼻腔涂抹莫匹罗星软膏5天，口服克林霉素1800 - 2400毫克，持续21天。
纳入19名患者。他们的平均年龄为36±14.5岁，男女比例为1.1。所有部位的筛查拭子中，63%（n = 12）为金黄色葡萄球菌阳性，其中包括4例耐甲氧西林金黄色葡萄球菌（MRSA）。在CMC方案治疗前，复发的中位时间为31天（平均52天）。平均复发次数为5.5±2.4次/年。在CMC方案治疗后，在16名接受完整随访的患者中，14名在9个月后痊愈。发生了2次复发，1次发生在MRSA携带者中，1次发生在皮肤病治疗不充分的患者中。未出现需要停止治疗的严重副作用。
复发性疖病涉及两条主要途径：危险因素和密切接触者的葡萄球菌定植。我们的方法安全有效，9个月后缓解率为87%。值得在更多参与者身上进行测试。
