莫匹罗星/氯己定预防耐甲氧西林金黄色葡萄球菌感染：一项使用莫匹罗星/氯己定和多粘菌素/妥布霉素预防插管患者获得性感染的安慰剂对照随机试验的事后分析
Mupirocin/chlorexidine to prevent methicillin-resistant Staphylococcus aureus infections: post hoc analysis of a placebo-controlled, randomized trial using mupirocin/chlorhexidine and polymyxin/tobramycin for the prevention of acquired infections in intubated patients.
作者信息
Camus C, Sebille V, Legras A, Garo B, Renault A, Le Corre P, Donnio P-Y, Gacouin A, Perrotin D, Le Tulzo Y, Bellissant E
机构信息
Service de Maladies Infectieuses et Réanimation Médicale, Hôpital de Pontchaillou, Centre Hospitalier Universitaire (CHU) de Rennes, Université de Rennes 1, 2 rue Henri Le Guilloux, 35033, Rennes cedex, France,
出版信息
Infection. 2014 Jun;42(3):493-502. doi: 10.1007/s15010-013-0581-1. Epub 2014 Jan 25.
PURPOSE
The reduction in acquired infections (AI) due to methicillin-resistant Staphylococcus aureus (MRSA) with the mupirocin/chlorhexidine (M/C) decontamination regimen has not been well studied in intubated patients. We performed post hoc analysis of a prior trial to assess the impact of M/C on MRSA AI and colonization.
METHODS
We conducted a multicenter, placebo-controlled, randomized, double-blind study with the primary aim to reduce all-cause AI. The two regimens used [topical polymyxin and tobramycin (P/T), nasal mupirocin with chlorhexidine body wash (M/C), or corresponding placebos for each regimen] were administered according to a 2 × 2 factorial design. Participants were intubated patients in the intensive care units of three French university hospitals. The patients enrolled in the study (n = 515) received either active P/T (n = 130), active M/C (n = 130), both active regimens (n = 129), or placebos only (n = 126) for the period of intubation and an additional 24 h. The incidence and incidence rates (per 1,000 study days) of MRSA AI were assessed. Due to the absence of a statistically significant interaction between the two regimens, analysis was performed at the margins by comparing all patient receiving M/C (n = 259) to all patients not receiving M/C (n = 256), and all patients receiving P/T (n = 259) to all patients not receiving P/T (n = 256).
RESULTS
Incidence [odds ratio (OR) 0.39, 95 % confidence interval (CI) (0.16-0.96), P = 0.04] and incidence rates [incidence rate ratio (IRR) 0.41, 95 % CI 0.17-0.97, P = 0.05] of MRSA AI were significantly lower with the use of M/C. We also observed an increase in the incidence (OR 2.50, 95 % CI 1.01-6.15, P = 0.05) and the incidence rate (IRR 2.90, 95 % CI 1.20-8.03, P = 0.03) of MRSA AI with the use of P/T.
CONCLUSION
Among our study cohort of intubated patients, the use of M/C significantly reduced MRSA AI.
目的
在插管患者中，对于莫匹罗星/氯己定（M/C）去污方案降低耐甲氧西林金黄色葡萄球菌（MRSA）所致获得性感染（AI）的效果尚未进行充分研究。我们对一项先前试验进行了事后分析，以评估M/C对MRSA AI和定植的影响。
方法
我们开展了一项多中心、安慰剂对照、随机、双盲研究，主要目的是降低全因AI。所使用的两种方案[局部用多粘菌素和妥布霉素（P/T）、鼻腔用莫匹罗星加氯己定沐浴液（M/C）或每种方案对应的安慰剂]按照2×2析因设计给药。参与者为法国三家大学医院重症监护病房的插管患者。纳入研究的患者（n = 515）在插管期间及额外24小时内接受活性P/T（n = 130）、活性M/C（n = 130）、两种活性方案（n = 129）或仅接受安慰剂（n = 126）。评估MRSA AI的发生率和发病率（每1000个研究日）。由于两种方案之间不存在统计学上的显著交互作用，通过比较所有接受M/C的患者（n = 259）与所有未接受M/C的患者（n = 256），以及所有接受P/T的患者（n = 259）与所有未接受P/T的患者（n = 256），在边缘进行分析。
结果
使用M/C时，MRSA AI的发生率[比值比（OR）0.39，95%置信区间（CI）（0.16 - 0.96），P = 0.04]和发病率[发病率比（IRR）0.41，95% CI 0.17 - 0.97，P = 0.05]显著更低。我们还观察到，使用P/T时，MRSA AI的发生率（OR 2.50，95% CI 1.01 - 6.15，P = 0.05）和发病率（IRR 2.90，95% CI 1.20 - 8.03，P = 0.03）有所增加。
结论
在我们的插管患者研究队列中，使用M/C可显著降低MRSA AI。
Zotero 插件