Maxwell Robert A, Croft Chasen A, Creech C Buddy, Thomsen Isaac, Soper Nicole, Brown Laura E, Mejia Vicente A, Dart Benjamin W, Barker Donald E
Am Surg. 2017 Dec 1;83(12):1407-1412.
The purpose of this study was to determine if a decolonization regimen reduces the frequency of methicillin-resistant Staphylococcus aureus (MRSA) infections and if colonization isolates are genetically related to subsequent infectious strains. Trauma patients admitted to the intensive care unit with positive MRSA nasal swabs were randomized to either daily chlorhexidine gluconate (CHG) baths and mupirocin (MUP) ointment to the nares or soap and water baths and placebo ointment for five days. Nasal swabs performed at the end of treatment and invasive MRSA infections during the remaining hospitalization were compared with the original nasal isolate via polymerase chain reaction for genetic relatedness as well as CHG and MUP resistance genes. Six hundred and seventy-eight intensive care unit admissions were screened, and 92 (13.6%) had positive (+) MRSA nasal swabs over a 22-month period ending in 3/2014. After the five day treatment period, there were 13 (59.1%) +MRSA second nasal swabs for CHG + MUP and 9 (90%) for soap and water baths and placebo, P = 0.114. No isolates tested positive for the MUP or CHG resistance genes mupA and qacA/B but 7 of 20 (35%) contained smr. There were seven (31.8%) MRSA infections in the CHG group and six (60%) for soap, P = 0.244. All 13 patients with MRSA infections had the same MRSA isolate present in the original nasal swab. There was no difference in all-cause Gram-negative or positive infections for CHG versus soap, 12 (54.5%) versus 7 (70%), P = 0.467. CHG + MUP are ineffective in eradicating MRSA from the anterior nares but may reduce the incidence of infection. Subsequent invasive MRSA infections are typically caused by the endogenous colonization strain.
本研究的目的是确定去定植方案是否能降低耐甲氧西林金黄色葡萄球菌（MRSA）感染的频率，以及定植菌株与随后的感染菌株是否存在基因关联。入住重症监护病房且MRSA鼻拭子检测呈阳性的创伤患者被随机分为两组，一组每天用葡萄糖酸氯己定（CHG）沐浴并在鼻孔涂抹莫匹罗星（MUP）软膏，另一组用肥皂和水沐浴并涂抹安慰剂软膏，为期五天。治疗结束时进行鼻拭子检测，并通过聚合酶链反应比较住院期间其余时间发生的侵袭性MRSA感染与原始鼻部分离株的基因关联性以及CHG和MUP耐药基因。在截至2014年3月的22个月期间，对678例入住重症监护病房的患者进行了筛查，其中92例（13.6%）MRSA鼻拭子检测呈阳性（+）。经过五天的治疗期后，CHG + MUP组有13例（59.1%）第二次鼻拭子检测MRSA呈阳性（+），肥皂和水沐浴及安慰剂组有9例（90%），P = 0.114。没有分离株对MUP或CHG耐药基因mupA和qacA/B检测呈阳性，但20株中有7株（35%）含有smr。CHG组有7例（31.8%）发生MRSA感染，肥皂组有6例（60%），P = 0.244。所有13例发生MRSA感染的患者在原始鼻拭子中均存在相同的MRSA分离株。CHG组与肥皂组在全因革兰氏阴性或阳性感染方面没有差异，分别为12例（54.5%）和7例（70%），P = 0.467。CHG + MUP在清除前鼻孔MRSA方面无效，但可能降低感染发生率。随后的侵袭性MRSA感染通常由内源性定植菌株引起。
