Selective use of intranasal mupirocin and chlorhexidine bathing and the incidence of methicillin-resistant Staphylococcus aureus colonization and infection among intensive care unit patients
Selective use of intranasal mupirocin and chlorhexidine bathing and the incidence of methicillin-resistant Staphylococcus aureus colonization and infection among intensive care unit patients
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DOI：
10.1086/520102
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发表时间：
2007-10-01
影响因子：
4.5
通讯作者：
Climo, Michael
中科院分区：
文献类型：
--
作者：
Ridenour, Glenn;Lampen, Russell;Climo, Michael
OBJECTIVE.目的：探讨洗必泰浸浴和莫匹罗星鼻内给药是否能降低耐甲氧西林金黄色葡萄球菌（MRSA）定植和重症监护病房（ICU）患者感染的发生率。在9个月的基线期（2003年1月13日至2003年10月12日）后，所有MRSA定植或感染的事件病例均通过在联合医疗-冠状动脉ICU中使用主动监测培养来确定，所有定植MRSA的患者均接受鼻内莫匹罗星治疗，并接受每日洗必泰浴。干预后，MRSA定植或感染的发病率下降了52%（发病率密度为8.45 vs 4.05例/1,000患者-天; P = 0.048）。所有MRSA分离株对氯己定仍然敏感;在监测培养鉴定的分离株中，莫匹罗星耐药的总体比率较低（4.4%），并且在干预期间没有增加。我们的结论是，选择性使用鼻内莫匹罗星和每日洗必泰洗澡的MRSA定植患者减少MRSA定植和感染的发生率，并有助于减少确定的主动监测文化。这一发现表明，额外的策略，以减少MRSA感染和定植的发病率，超越扩大监测可能是必要的。
OBJECTIVE. To determine whether the use of chlorhexidine bathing and intranasal mupirocin therapy among patients colonized with methicillin-resistant Staphylococcus aureus ( MRSA) would decrease the incidence of MRSA colonization and infection among intensive care unit ( ICU) patients.METHODS. After a 9-month baseline period ( January 13, 2003, through October 12, 2003) during which all incident cases of MRSA colonization or infection were identified through the use of active-surveillance cultures in a combined medical-coronary ICU, all patients colonized with MRSA were treated with intranasal mupirocin and underwent daily chlorhexidine bathing.RESULTS. After the intervention, incident cases of MRSA colonization or infection decreased 52% ( incidence density, 8.45 vs 4.05 cases per 1,000 patient-days; P = .048). All MRSA isolates remained susceptible to chlorhexidine; the overall rate of mupirocin resistance was low ( 4.4%) among isolates identified by surveillance cultures and did not increase during the intervention period.CONCLUSIONS. We conclude that the selective use of intranasal mupirocin and daily chlorhexidine bathing for patients colonized with MRSA reduced the incidence of MRSA colonization and infection and contributed to reductions identified by active-surveillance cultures. This finding suggests that additional strategies to reduce the incidence of MRSA infection and colonization-beyond expanded surveillance may be needed.