Archer G L, Armstrong B C
J Infect Dis. 1983 Apr;147(4):642-9. doi: 10.1093/infdis/147.4.642.
The changes in staphylococcal flora induced by antibiotic prophylaxis with rifampin and nafcillin in combination among patients undergoing cardiac valve surgery were compared to those in patients undergoing coronary artery bypass surgery concurrently, who received only cefazolin. Rifampin-nafcillin prophylaxis eradicated carriage of Staphylococcus aureus at a significantly higher rate than did cefazolin (eradicated carriage of 89% vs. 48%, respectively; P less than 0.01); however, by the seventh postoperative day, 75% of the patients receiving rifampin and nafcillin had rifampin-resistant, coagulase-negative staphylococcal perianal floras, compared to 19% of those who received cefazolin (P less than 0.001). Patients receiving rifampin-nafcillin were colonized as frequently (66%) with coagulase-negative staphylococci resistant to gentamicin and methicillin as were those receiving cefazolin (68%). Patients in the coronary intensive care unit who received no antibiotics were infrequently colonized with either rifampin-resistant (none) or gentamicin- and methicillin-resistant (11%) staphylococci. Antibiotic prophylaxis may, therefore, be an important factor in perpetuating the hospital reservoir for antibiotic-resistant, coagulase-negative staphylococci.
将接受心脏瓣膜手术的患者联合使用利福平与萘夫西林进行抗生素预防所诱导的葡萄球菌菌群变化，与同期接受冠状动脉搭桥手术且仅接受头孢唑林治疗的患者的菌群变化进行了比较。利福平 - 萘夫西林预防方案清除金黄色葡萄球菌携带的比例显著高于头孢唑林（分别为89%和48%；P<0.01）；然而，到术后第7天，接受利福平和萘夫西林治疗的患者中有75%出现了耐利福平、凝固酶阴性葡萄球菌肛周菌群，而接受头孢唑林治疗的患者中这一比例为19%（P<0.001）。接受利福平 - 萘夫西林治疗的患者对庆大霉素和甲氧西林耐药的凝固酶阴性葡萄球菌定植率（66%）与接受头孢唑林治疗的患者（68%）相当。在冠状动脉重症监护病房未接受抗生素治疗的患者中，耐利福平（无）或耐庆大霉素和甲氧西林（11%）的葡萄球菌定植情况很少见。因此，抗生素预防可能是医院中耐抗生素凝固酶阴性葡萄球菌储存库持续存在的一个重要因素。
