Kim Jae-Seok, Chung Yun Kyung, Lee Seung Soon, Lee Jeong-A, Kim Han-Sung, Park Eun Young, Shin Kyong-Sok, Kang Bog Soun, Lee Hee Jung, Kang Hyun Joo
Department of Laboratory Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea.
Department of Occupational and Environmental Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea.
Am J Infect Control. 2016 Dec 1;44(12):1520-1525. doi: 10.1016/j.ajic.2016.04.252. Epub 2016 Aug 9.
Universal decolonization is recommended in intensive care units (ICUs) that have unacceptably high rates of methicillin-resistant Staphylococcus aureus (MRSA) despite implementation of basic prevention strategies.
An interrupted time series study was performed to evaluate the effect of daily chlorhexidine bathing on the acquisition of MRSA in a medical ICU with MRSA endemicity. There was a 14-month control period and a 16-month chlorhexidine bathing period. Segmented Poisson regression analysis was performed to assess the impact of daily chlorhexidine bathing on the incidence density of MRSA. Also, chlorhexidine susceptibility testing with polymerase chain reaction for the qacA/B gene was performed on MRSA isolates collected during the chlorhexidine bathing period.
There was a significant reduction in trend (-0.056; 95% confidence interval, -0.095 to -0.017; P = .005) of incidence density of MRSA despite a significant increase in both level and trend of MRSA prevalence rates during the chlorhexidine bathing period. However, there was no significant reduction in level of incidence density of MRSA during the interventional period. Minimum inhibitory concentration of chlorhexidine and the detection rates of the qacA/B gene for a total of 174 MRSA isolates did not increase during the chlorhexidine bathing period.
Daily chlorhexidine bathing resulted in a significantly decreasing trend of MRSA acquisition rates irrespective of increased MRSA prevalence rates in the medical ICU. There was no shift of chlorhexidine-resistant MRSA strains.
对于尽管已实施基本预防策略但耐甲氧西林金黄色葡萄球菌（MRSA）感染率仍高得令人无法接受的重症监护病房（ICU），建议进行普遍去定植。
进行了一项中断时间序列研究，以评估在一个存在MRSA地方流行的内科ICU中，每日使用洗必泰沐浴对MRSA感染的影响。有一个14个月的对照期和一个16个月的洗必泰沐浴期。进行分段泊松回归分析，以评估每日使用洗必泰沐浴对MRSA发病密度的影响。此外，对在洗必泰沐浴期收集的MRSA分离株进行了洗必泰敏感性测试及qacA/B基因的聚合酶链反应检测。
尽管在洗必泰沐浴期MRSA患病率的水平和趋势均显著增加，但MRSA发病密度的趋势有显著降低（-0.056；95%置信区间，-0.095至-0.017；P = 0.005）。然而，在干预期内MRSA发病密度的水平没有显著降低。在洗必泰沐浴期，总共174株MRSA分离株的洗必泰最低抑菌浓度及qacA/B基因的检出率没有增加。
在内科ICU中，无论MRSA患病率增加与否，每日使用洗必泰沐浴均导致MRSA感染率呈显著下降趋势。耐洗必泰MRSA菌株未出现变化。
