Nelson M U, Bizzarro M J, Dembry L M, Baltimore R S, Gallagher P G
Division of Perinatal Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA.
1] Division of Infectious Disease, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA [2] Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT, USA [3] Department of Infection Control, Yale-New Haven Hospital, New Haven, CT, USA.
J Perinatol. 2014 Sep;34(9):653-5. doi: 10.1038/jp.2014.125. Epub 2014 Jul 10.
The REDUCE MRSA Trial (Randomized Evaluation of Decolonization vs Universal Clearance to Eliminate Methicillin-Resistant Staphylococcus aureus), a large multicenter, randomized controlled trial in adult intensive care units (ICUs), found universal decolonization to be more effective than surveillance and isolation procedures with or without targeted decolonization for reducing rates of MRSA-positive clinical cultures. The Agency for Healthcare Research and Quality and the Centers for Disease Control and Prevention subsequently published protocols for implementing universal decolonization in ICUs based on the trial's methods. Caution should be exercised before widely adopting these procedures in neonatal intensive care units (NICUs), particularly strategies that involve bathing with chlorhexidine and mupirocin application due to the potential for adverse events in their unique patient population, especially preterm infants. Large multicenter trials in the NICUs are needed to evaluate the efficacy, short- and long-term safety, and cost effectiveness of these strategies prior to their widespread implementation.
“减少耐甲氧西林金黄色葡萄球菌（MRSA）试验”（去定植与普遍清除以消除耐甲氧西林金黄色葡萄球菌的随机评估）是一项在成人重症监护病房（ICU）中进行的大型多中心随机对照试验，该试验发现，对于降低MRSA阳性临床培养率而言，普遍去定植比采用或不采用针对性去定植的监测和隔离程序更为有效。医疗保健研究与质量局以及疾病控制与预防中心随后根据该试验的方法发布了在ICU中实施普遍去定植的方案。在新生儿重症监护病房（NICU）广泛采用这些程序之前应谨慎行事，特别是那些涉及使用洗必泰沐浴和应用莫匹罗星的策略，因为在其独特的患者群体（尤其是早产儿）中可能会出现不良事件。在广泛实施这些策略之前，需要在NICU中进行大型多中心试验，以评估其疗效、短期和长期安全性以及成本效益。
