Kavanagh Kevin T, Calderon Lindsay E, Saman Daniel M, Abusalem Said K
Health Watch USA, 3396 Woodhaven Dr, Somerset, KY 42503, USA.
Eastern Kentucky University, Richmond, KY, USA.
Antimicrob Resist Infect Control. 2014 May 14;3:18. doi: 10.1186/2047-2994-3-18. eCollection 2014.
The Agency for Healthcare Research & Quality (AHRQ) found that Methicillin-resistant Staphylococcus aureus (MRSA) is associated with up to 375,000 infections and 23,000 deaths in the United States. It is a major cause of surgical site infections, with a higher mortality and longer duration of care than Methicillin-sensitive Staphylococcus aureus. A multifactorial bundled approach is needed to control this epidemic, with single interventions unlikely to have a significant impact on attenuating MRSA infection rates. Active surveillance has been studied in a wide range of surgical patients, including surgical intensive care and non-intensive care units; cardiac, vascular, orthopedic, obstetric, head and neck cancer and gastrostomy patients. There is sufficient evidence demonstrating a beneficial effect of surveillance and eradication prior to surgery to recommend its use on an expanded basis. Studies on MRSA surveillance in surgical patients that were published over the last 10 years were reviewed. In at least five of these studies, the MRSA colonization status of patients was reported to be a factor in preoperative antibiotic selection, with the modification of treatment regiments including the switching to vancomycin or teicoplanin in MRSA positive preoperative patients. Several authors also used decolonization protocols on all preoperative patients but used surveillance to determine the duration of the decolonization. Universal decolonization of all patients, regardless of MRSA status has been advocated as an alternative prevention protocol in which surveillance is not utilized. Concern exists regarding antimicrobial stewardship. The daily and universal use of intranasal antibiotics and/or antiseptic washes may encourage the promotion of bacterial resistance and provide a competitive advantage to other more lethal organisms. Decolonization protocols which indiscriminately neutralize all bacteria may not be the best approach. If a patient's microbiome is markedly challenged with antimicrobials, rebuilding it with replacement commensal bacteria may become a future therapy. Preoperative MRSA surveillance allows the selection of appropriate prophylactic antibiotics, the use of extended decolonization protocols in positive patients, and provides needed data for epidemiological studies.
医疗保健研究与质量局（AHRQ）发现，耐甲氧西林金黄色葡萄球菌（MRSA）在美国导致了多达37.5万例感染和2.3万例死亡。它是手术部位感染的主要原因，与甲氧西林敏感金黄色葡萄球菌相比，死亡率更高，护理时间更长。需要采取多因素综合措施来控制这一疫情，单一干预措施不太可能对降低MRSA感染率产生重大影响。已在广泛的手术患者中研究了主动监测，包括外科重症监护病房和非重症监护病房；心脏、血管、骨科、产科、头颈癌和胃造口术患者。有充分证据表明，术前监测和根除有有益效果，建议扩大其使用范围。对过去10年发表的关于手术患者MRSA监测的研究进行了综述。在这些研究中，至少有五项报告称患者的MRSA定植状态是术前抗生素选择的一个因素，治疗方案的调整包括术前MRSA检测呈阳性的患者改用万古霉素或替考拉宁。几位作者还对所有术前患者采用了去定植方案，但通过监测来确定去定植的持续时间。有人主张对所有患者进行普遍去定植，无论其MRSA状态如何，这是一种不使用监测的替代预防方案。人们对抗菌药物管理存在担忧。每日普遍使用鼻内抗生素和/或抗菌洗剂可能会助长细菌耐药性，并为其他更具致命性的微生物提供竞争优势。不加区分地中和所有细菌的去定植方案可能不是最佳方法。如果患者的微生物群受到抗菌药物的显著挑战，用替代共生细菌重建它可能会成为未来的一种治疗方法。术前MRSA监测有助于选择合适的预防性抗生素，对检测呈阳性的患者使用延长的去定植方案，并为流行病学研究提供所需数据。
