Control of imported and acquired methicillin-resistant Staphylococcus aureus (MRSA) in mechanically ventilated patients:: a dose-response study of enteral vancomycin to reduce absolute carriage and infection
Control of imported and acquired methicillin-resistant Staphylococcus aureus (MRSA) in mechanically ventilated patients:: a dose-response study of enteral vancomycin to reduce absolute carriage and infection
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DOI：
10.1177/0310057x0503300312
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发表时间：
2005-06-01
影响因子：
1.5
通讯作者：
Gullo, A
中科院分区：
文献类型：
--
作者：
Viviani, M;van Saene, HKF;Gullo, A
本研究旨在利用“绝对携带”的概念，将携带率乘以携带水平，量化患者提供的生命来源；并比较低剂量和高剂量口咽万古霉素凝胶对MRSA绝对携带和感染的影响。共纳入265例患者，其中126例为MRSA阳性。55名患者在第一年接受2%万古霉素凝胶治疗，50名患者在第二年接受4%万古霉素凝胶治疗，所有符合条件的患者在入院时进行喉咙和直肠的监测拭子，然后每周两次。一旦监测培养为MRSA阳性，万古霉素方案就开始了。这些患者每天接受1克肠内万古霉素，分4次服用。在第一年，除肠内溶液外，2%万古霉素凝胶4 ml （80 mg）分四次应用于口咽部（A组）。第二年使用4%万古霉素凝胶4 ml (160 mg) （B组）。两组的绝对运载量都很高：A组为3.6，b组为3.2。与2%万古霉素方案相比，4%万古霉素方案显著降低了绝对运载量：2.6比1.5 （P < 0.01）。第二年继发性内源性感染显著减少：7例对15例（P < 0.05）。共处理微生物样品3588份。未检出万古霉素中等敏感性金黄色葡萄球菌（VISA）和耐万古霉素肠球菌（VRE）。
This study aimed to quantify the animate source provided by the patients using the concept of "absolute carriage" by multiplying the carrier rate by the level of carriage; and to compare the impact of a low and high dose of an oropharyngeal vancomycin gel on the absolute MRSA carriage and infection.In all, 265 patients were included, 126 were MRSA positive. Fifty-five patients received 2% vancomycin gel during the first year whilst 4% vancomycin gel was given to 50 patients during the second year Surveillance swabs of throat and rectum were obtained from all eligible patients on admission and then twice weekly. The vancomycin protocol was started as soon as the surveillance cultures were positive for MRSA. Those patients received one gram of enteral vancomycin daily, divided into four doses. During the first year 2% vancomycin gel 4 ml (80 mg) was applied in the oropharynx in four doses in addition to the enteral solution (Group A). During the second year 4% vancomycin gel 4 ml (160 mg) was used (Group B).The absolute carriage was high during both periods: 3.6 for Group A, and 3.2 for Group B. The 4% vancomycin protocol significantly reduced the absolute carriage, compared to the 2% vancomycin protocol: 2.6 versus 1.5 (P < 0.01). Significant reduction in secondary endogenous infections was found in the second year: seven versus 15 patients (P < 0.05). A total of 3,588 microbiological samples were processed. Neither Staphylococcus aureus with intermediate sensitivity to vancomycin (VISA) nor vancomycin-resistant enterococci (VRE) were detected.