Mupirocin and Chlorhexidine Resistance in Staphylococcus aureus in Patients with Community-Onset Skin and Soft Tissue Infections
Mupirocin and Chlorhexidine Resistance in Staphylococcus aureus in Patients with Community-Onset Skin and Soft Tissue Infections
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DOI：
10.1128/aac.01633-12
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发表时间：
2013-01-01
影响因子：
4.9
通讯作者：
Burnham, Carey-Ann D.
中科院分区：
文献类型：
--
作者：
Fritz, Stephanie A.;Hogan, Patrick G.;Burnham, Carey-Ann D.
去殖民化措施，包括莫匹罗星和氯己定，通常用于预防金黄色葡萄球菌皮肤和软组织感染（SSTI）。本研究的目的是确定高水平的莫匹罗星和洗必泰耐药的流行在沙门氏菌。在莫匹罗星和洗必泰给药前后从SSTI患者中回收的金黄色葡萄球菌菌株，并确定基线时携带莫匹罗星或洗必泰耐药菌株是否排除了S.金黄色葡萄球菌根除我们招募了1,089名社区发病的SSTI患者，有或没有S。金黄色葡萄球菌定植。除了常规护理外，483名患者参加了去殖民化试验：408名接受鼻内莫匹罗星（有或没有抗菌浴），258名进行洗必泰沐浴。患者随访长达12个月，重复定植培养。所有鼠伤寒沙门测试金黄色葡萄球菌分离株的高水平莫匹罗星和氯己定抗性。基线时，23/1，089（2.1%）例患者携带莫匹罗星耐药S。10/1,089（0.9%）例患者携带耐洗必泰的金黄色葡萄球菌。金黄色。在4名接受莫匹罗星治疗的患者中，他们携带莫匹罗星耐药的S。对于基线时的金黄色葡萄球菌菌株，100%在1个月时保持定殖，相比之下，基线时无莫匹罗星抗性的324名患者中有44%（P = 0.041）。在2例使用洗必泰的患者中，他们携带耐洗必泰的S。在基线时的金黄色葡萄球菌菌株中，50%在1个月时保持定殖，而在基线时无氯己定抗性的209名患者中为48%（P = 1.0）。莫匹罗星和洗必泰耐药的总体流行率在链球菌中较低。金黄色葡萄球菌分离株从门诊患者中恢复，但在携带莫匹罗星耐药的患者中根除努力不太成功。金黄色葡萄球菌菌株。
Decolonization measures, including mupirocin and chlorhexidine, are often prescribed to prevent Staphylococcus aureus skin and soft tissue infections (SSTI). The objective of this study was to determine the prevalence of high-level mupirocin and chlorhexidine resistance in S. aureus strains recovered from patients with SSTI before and after mupirocin and chlorhexidine administration and to determine whether carriage of a mupirocin-or chlorhexidine-resistant strain at baseline precluded S. aureus eradication. We recruited 1,089 patients with community-onset SSTI with or without S. aureus colonization. In addition to routine care, 483 patients were enrolled in a decolonization trial: 408 received intranasal mupirocin (with or without antimicrobial baths), and 258 performed chlorhexidine body washes. Patients were followed for up to 12 months with repeat colonization cultures. All S. aureus isolates were tested for high-level mupirocin and chlorhexidine resistance. At baseline, 23/1,089 (2.1%) patients carried a mupirocin-resistant S. aureus strain and 10/1,089 (0.9%) patients carried chlorhexidine-resistant S. aureus. Of 4 patients prescribed mupirocin, who carried a mupirocin-resistant S. aureus strain at baseline, 100% remained colonized at 1 month compared to 44% of the 324 patients without mupirocin resistance at baseline (P = 0.041). Of 2 patients prescribed chlorhexidine, who carried a chlorhexidine-resistant S. aureus strain at baseline, 50% remained colonized at 1 month compared to 48% of the 209 patients without chlorhexidine resistance at baseline (P = 1.0). The overall prevalence of mupirocin and chlorhexidine resistance is low in S. aureus isolates recovered from outpatients, but eradication efforts were less successful in patients carrying a mupirocin-resistant S. aureus strain at baseline.