Hedin G, Hambraeus A
Department of Clinical Microbiology, University Hospital, Uppsala, Sweden.
J Hosp Infect. 1993 May;24(1):47-61. doi: 10.1016/0195-6701(93)90089-i.
The aim of this study was to establish whether long-term use of chlorhexidine would prevent skin colonization by antibiotic-resistant Staphylococcus epidermidis. Ten nurses, working on a ward for haematological disorders, volunteered to participate in the test. They washed one arm every morning for three weeks with chlorhexidine gluconate, ('Hibiscrub' ICI Pharmaceuticals). The other arm served as a negative control. Samples from the antecubital fossa of both arms were taken two to three times a week during the wash period and two weeks thereafter, giving a total of 216 samples. The appearance of resistant S. epidermidis with different antibiograms was analysed. During the wash period the total bacterial counts and the counts of the resistant S. epidermidis strains on the test arm were both about one-tenth of those on the control arm, a significant difference (P < 0.05). Moreover, there were significantly fewer resistant S. epidermidis on the test arm, 1.3 per sample, than on the control arm, 2.5 per sample (P < 0.01). Most of the resistant S. epidermidis were only found once or a few times on the same site, after which they disappeared, though a few persisted on the skin even during 'Hibiscrub' washing. In an agar dilution test, chlorhexidine minimum inhibitory concentrations (MICs) of persisting strains were the same as for strains disappearing from the skin following 'Hibiscrub' washing, 1.0 or 2.0 mg l-1, but somewhat higher than MICs of strains isolated from healthy carriers outside the hospital whose MICs were 0.5 mg l-1. The relative contribution to the skin counts by those S. epidermidis strains found only occasionally were compared with those found repeatedly but no difference in reduction was found between these categories during 'Hibiscrub' washing.
本研究的目的是确定长期使用氯己定是否能预防耐抗生素表皮葡萄球菌在皮肤上的定植。十名在血液疾病病房工作的护士自愿参与了这项试验。她们每天早晨用葡萄糖酸氯己定（“洗必泰擦洗剂”，帝国化学工业公司制药部）清洗一侧手臂，为期三周。另一侧手臂作为阴性对照。在清洗期以及之后的两周内，每周从双臂的肘前窝采集两到三次样本，共采集了216个样本。分析了具有不同抗菌谱的耐抗生素表皮葡萄球菌的出现情况。在清洗期，试验侧手臂上的总细菌计数和耐抗生素表皮葡萄球菌菌株计数均约为对照侧手臂的十分之一，差异显著（P<0.05）。此外，试验侧手臂上耐抗生素表皮葡萄球菌的数量明显少于对照侧手臂，试验侧每个样本为1.3个，对照侧每个样本为2.5个（P<0.01）。大多数耐抗生素表皮葡萄球菌仅在同一部位出现过一次或几次，之后就消失了，不过即使在使用“洗必泰擦洗剂”清洗期间，仍有少数菌株持续存在于皮肤上。在琼脂稀释试验中，持续存在的菌株的氯己定最低抑菌浓度（MIC）与在使用“洗必泰擦洗剂”清洗后从皮肤上消失的菌株相同，为1.0或2.0mg/l，但略高于从医院外健康携带者身上分离出的菌株的MIC，后者为0.5mg/l。将偶尔发现的表皮葡萄球菌菌株与反复发现的菌株对皮肤细菌计数的相对贡献进行了比较，但在使用“洗必泰擦洗剂”清洗期间，这两类菌株在减少数量方面没有差异。
