Preventing Surgical-Site Infections in Nasal Carriers of Staphylococcus aureus
Preventing Surgical-Site Infections in Nasal Carriers of Staphylococcus aureus
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DOI：
10.1056/nejmoa0808939
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发表时间：
2010-01-07
影响因子：
158.5
通讯作者：
Vos, Margreet C.
中科院分区：
文献类型：
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作者：
Bode, Lonneke G. M.;Kluytmans, Jan A. J. W.;Vos, Margreet C.
鼻内携带金黄色葡萄球菌的患者，其发生与卫生保健相关的感染的风险增加。在一项随机、双盲、安慰剂对照的多中心试验中，我们评估了是否快速识别S。通过实时聚合酶链反应（PCR）检测金黄色葡萄球菌鼻载体，然后用莫匹罗星鼻软膏和洗必泰肥皂治疗，降低了医院相关性S.从2005年10月到2007年6月，总共有6771名患者在入院时接受了筛查。1251例患者的1270份鼻拭子中检出S。金黄色。我们在意向治疗分析中纳入了917例患者，其中808例（88.1%）接受了外科手术。所有的S。在PCR测定中鉴定的金黄色葡萄球菌菌株对甲氧西林和莫匹罗星敏感。S.莫匹罗星-氯己定组的金黄色葡萄球菌感染率为3.4%（504名患者中的17名），而安慰剂组为7.7%（413名患者中的32名）（感染的相对风险，0.42; 95%置信区间[CI]，0.23至0.75）。莫匹罗星-氯己定治疗对深部尿道部位感染的影响最明显（相对风险，0.21; 95%CI，0.07 - 0.62）。两组的全因住院死亡率无显著差异。安慰剂组发生医院感染的时间短于莫匹罗星-氯己定组（P = 0.005）。通过快速筛查和消除鼻内携带金黄色葡萄球菌的细菌，可以减少医院内获得性感染。金黄色葡萄球菌（当前对照试验编号，ISRCTN 56186788。）
BACKGROUNDNasal carriers of Staphylococcus aureus are at increased risk for health care-associated infections with this organism. Decolonization of nasal and extranasal sites on hospital admission may reduce this risk.METHODSIn a randomized, double-blind, placebo-controlled, multicenter trial, we assessed whether rapid identification of S. aureus nasal carriers by means of a real-time polymerase-chain-reaction (PCR) assay, followed by treatment with mupirocin nasal ointment and chlorhexidine soap, reduces the risk of hospital-associated S. aureus infection.RESULTSFrom October 2005 through June 2007, a total of 6771 patients were screened on admission. A total of 1270 nasal swabs from 1251 patients were positive for S. aureus. We enrolled 917 of these patients in the intention-to-treat analysis, of whom 808 (88.1%) underwent a surgical procedure. All the S. aureus strains identified on PCR assay were susceptible to methicillin and mupirocin. The rate of S. aureus infection was 3.4% (17 of 504 patients) in the mupirocin-chlorhexidine group, as compared with 7.7% (32 of 413 patients) in the placebo group (relative risk of infection, 0.42; 95% confidence interval [CI], 0.23 to 0.75). The effect of mupirocin-chlorhexidine treatment was most pronounced for deep surgical-site infections (relative risk, 0.21; 95% CI, 0.07 to 0.62). There was no significant difference in all-cause in-hospital mortality between the two groups. The time to the onset of nosocomial infection was shorter in the placebo group than in the mupirocin-chlorhexidine group (P = 0.005).CONCLUSIONSThe number of surgical-site S. aureus infections acquired in the hospital can be reduced by rapid screening and decolonizing of nasal carriers of S. aureus on admission. (Current Controlled Trials number, ISRCTN56186788.)