Sasi S P, Sistla S C, Sistla S, Karthikeyan V S, Mahalakshmy T, Ali S M, Vijayaraghavan N
Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
Int J Clin Pract. 2015 Mar;69(3):366-74. doi: 10.1111/ijcp.12578. Epub 2015 Feb 4.
Two-thirds of surgical site infections (SSI) because of Staphylococcus aureus are caused by Methicillin resistant Staphylococcus aureus (MRSA). This study was done to assess the efficacy of topical 2% mupirocin with 2% chlorhexidine gluconate body wash in decolonizing MRSA and its impact in preventing SSI because of MRSA. The various risk factors associated with MRSA carriers and SSI were also studied because of paucity of data in the developing world.
We did a non-randomised interventional trial in 602 patients undergoing elective general surgical operations. All patients in case (297) group were screened for MRSA and those positive were decolonised with topical 2% mupirocin calcium ointment and daily baths with 2% chlorhexidine antiseptic solution for 5 days. Control (305) group patients underwent surgery without decolonisation. Postoperatively, all patients were followed up for SSI for 30 days.
Prevalence of MRSA carriers was 7.5% with decolonisation rate of 95.2%. The SSI incidence was 21.3%. The significant risk factors for SSI were type of anaesthesia (p = 0.002), duration of surgery (p = 0.001) and preoperative hospital stay (p = 0.001). There was a significant association between MRSA carrier positivity at the time of surgery and SSI (p = 0.041).
There was no reduction in rate of SSI or other nosocomial infections in patients undergoing elective general surgical operations following preoperative MRSA decolonisation with 2% mupirocin and 2% chlorhexidine gluconate in MRSA carriers. MRSA carrier status was a significant risk factor for SSI but not for other nosocomial infections.
三分之二的金黄色葡萄球菌引起的手术部位感染（SSI）是由耐甲氧西林金黄色葡萄球菌（MRSA）所致。本研究旨在评估局部应用2%莫匹罗星联合2%葡萄糖酸氯己定沐浴露对MRSA去定植的效果及其对预防MRSA所致SSI的影响。鉴于发展中国家相关数据匮乏，还对与MRSA携带者和SSI相关的各种危险因素进行了研究。
我们对602例行择期普通外科手术的患者进行了一项非随机干预试验。病例组（297例）所有患者均接受MRSA筛查，阳性者用2%莫匹罗星钙软膏局部用药，并每日用2%氯己定消毒液沐浴5天进行去定植。对照组（305例）患者未进行去定植直接接受手术。术后，对所有患者进行30天的SSI随访。
MRSA携带者的患病率为7.5%，去定植率为95.2%。SSI发生率为21.3%。SSI的显著危险因素为麻醉类型（p = 0.002）、手术时间（p = 0.001）和术前住院时间（p = 0.001）。手术时MRSA携带者阳性与SSI之间存在显著关联（p = 0.041）。
对于MRSA携带者，术前用2%莫匹罗星和2%葡萄糖酸氯己定进行MRSA去定植后，择期普通外科手术患者的SSI或其他医院感染率并未降低。MRSA携带者状态是SSI的显著危险因素，但不是其他医院感染的危险因素。
