A randomized, controlled trial of chlorhexidine-soaked cloths to reduce methicillin-resistant and methicillin-susceptible Staphylococcus aureus carriage prevalence in an urban jail.
A randomized, controlled trial of chlorhexidine-soaked cloths to reduce methicillin-resistant and methicillin-susceptible Staphylococcus aureus carriage prevalence in an urban jail.
复制标题
一项随机对照试验，使用氯己定浸泡的布来降低城市监狱中耐甲氧西林和甲氧西林敏感的金黄色葡萄球菌携带率。
DOI：
10.1086/678606
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发表时间：
2014
影响因子：
4.5
通讯作者：
Daum,RobertS
中科院分区：
文献类型：
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作者：
David,MichaelZ;Siegel,JaneD;Henderson,Janet;Leos,Greg;Lo,Kaming;Iwuora,Jerry;Porsa,Esmaeil;Schumm,LPhilip;Boyle-Vavra,Susan;Daum,RobertS
目标。评估限制社区相关耐甲氧西林金黄色葡萄球菌（MRSA）传播的干预措施。随机对照试验。环境。德克萨斯州达拉斯县监狱。参与者。共有4196名在押人员在68个拘留池中。方法。拘留池被随机分为3组：第一组，在押人员使用含有葡萄糖酸氯己定（CHG）的布，每周3次清洁其整个皮肤表面，持续6个月；第二组收到相同的只含水的布；第三组不进行皮肤治疗。在研究期间，所有新来的被拘留者都被邀请参加。结果：基线时，947名入组患者的41.2%分离出金黄色葡萄球菌，8.0%（鼻腔和/或手部）分离出MRSA。平均参与率为47%。6个月时，第3组的MRSA携带率为10.0%，第1组为8.7%(估计绝对风险降低[95%置信区间（CI）], 1.4%[- 4.8%至7.1%]；P = .655)。6个月时，第3组金黄色葡萄球菌携带率为51.1%，第1组为40.7%（绝对风险降低[95% CI]， 10.4% [0.01%-20.1%], P = 0.047），第2组为42.8%（绝对风险降低[95% CI]， 8.3% [- 1.4% - 18.0%], P = 0.099）。被拘留者用CHG清洁皮肤6个月，与没有干预相比，金黄色葡萄球菌携带明显减少，使用水布产生不显著但相似的减少。使用CHG布后，MRSA携带量无显著下降。临床试验注册。clinicaltrials .gov标识符NCT00785200。
Objective.To assess an intervention to limit community-associated methicillin-resistant Staphylococcus aureus (MRSA) dissemination.Design.Randomized, controlled trial.Setting.County Jail, Dallas, Texas.Participants.A total of 4,196 detainees in 68 detention tanks.Methods.Tanks were randomly assigned to 1 of 3 groups: in group 1, detainees received cloths that contained chlorhexidine gluconate (CHG) to clean their entire skin surface 3 times per week for 6 months; group 2 received identical cloths containing only water; and group 3 received no skin treatment. During the study, all newly arrived detainees were invited to enroll. Nares and hand cultures were obtained at baseline and from all current enrollees at 2 and 6 months.Results.At baseline, S. aureus was isolated from 41.2% and MRSA from 8.0% (nares and/or hand) of 947 enrollees. The average participation rate was 47%. At 6 months, MRSA carriage was 10.0% in group 3 and 8.7% in group 1 tanks (estimated absolute risk reduction [95% confidence interval (CI)], 1.4% [−4.8% to 7.1%]; P = .655). At 6 months, carriage of any S. aureus was 51.1% in group 3, 40.7% in group 1 (absolute risk reduction [95% CI], 10.4% [0.01%–20.1%]; P = .047), and 42.8% (absolute risk reduction [95% CI], 8.3% [−1.4% to 18.0%]; P = .099) in group 2.Conclusions.Skin cleaning with CHG for 6 months in detainees, compared with no intervention, significantly decreased carriage of S. aureus, and use of water cloths produced a nonsignificant but similar decrease. A nonsignificant decrease in MRSA carriage was found with CHG cloth use.Trial registration.ClinicalTrials.gov identifier NCT00785200.