Antimicrobial Therapy for Methicillin-Resistant Staphylococcus aureus Colonization in Residents and Staff of a Veterans Affairs Nursing Home Care Unit
Antimicrobial Therapy for Methicillin-Resistant Staphylococcus aureus Colonization in Residents and Staff of a Veterans Affairs Nursing Home Care Unit
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退伍军人事务部疗养院居民和工作人员中耐甲氧西林金黄色葡萄球菌定植的抗菌治疗
DOI：
10.2307/30147118
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发表时间：
1992
期刊：
影响因子：
--
通讯作者：
T. T. Ward
中科院分区：
文献类型：
--
作者：
L. Strausbaugh;C. Jacobson;D. Sewell;S. Potter;T. T. Ward
摘要：目的：评价抗菌药物治疗对熟练护理机构中耐甲氧西林金黄色葡萄球菌（MRSA）患者和工作人员的影响，并评估环境作为MRSA潜在储存库的作用。设计：作为控制养老院MRSA爆发的综合方案的一部分，根据MRSA定植的部位和程度，患者和工作人员接受三种抗菌素去定植方案中的一种。在治疗期间以及治疗结束后的第2、7、14和30天进行随访培养。在治疗期间和治疗后对患者的无生命环境（睡衣、床单和地板）进行培养，对治疗前获得的54株MRSA菌株和治疗后恢复的44株MRSA菌株进行抗菌药敏试验。参与者：36名患者和7名护士在1个或多个地点感染了MRSA。干预措施：利福平、甲氧苄啶-磺胺甲恶唑和克林霉素单独或联合使用5或10天的去菌落治疗，同时采取其他感染控制措施对抗MRSA暴发。结果：36例NHCU患者中有20例（56%）在30天的随访期间持续定殖或重新定殖MRSA。治疗第3天的阳性培养经常发现患者随后表现出持续性或复发性定植。治疗前，92%的MRSA分离株对利福平敏感，而治疗后获得的分离株中只有43%对利福平敏感。20例持续或复发定植的患者中有16例（80%）在治疗后分离出耐利福平的MRSA菌株，在治疗期间和治疗后获得的125例环境培养物中有23例（18%）MRSA阳性，而在107例成功去定植的患者中有9例（8%）MRSA阳性。结论：疫情控制计划的去菌落部分被认为是无效的和潜在的危险，因为超过一半的患者持续或复发定植，并且在治疗后分离的MRSA菌株中发现了大量的抗菌素耐药性，特别是对利福平的耐药性，以及可能从其他人类或环境来源重新获得MRSA是阻碍去菌落努力的两个因素。
Abstract Objective: TO evaluate the effect of antimicrobial therapy on patients and staff colonized with methicillin-resistant Staphylococcus aureus (MRSA) in a skilled nursing facility and to assess the role of the environment as a potential reservoir for MRSA in the nursing home setting. Design: As part of a comprehensive program to control an MRSA outbreak in a nursing home, patients and staff colonized with MRSA received 1 of 3 antimicrobial decolonization regimens depending upon the site and extent of colonization. Followup cultures were performed during therapy and on days 2, 7, 14, and 30 following the completion of therapy. Cultures of tbe patients' inanimate environment (pajamas, sheet, and floor) were obtained during and after therapy Antimicrobial susceptibility tests were performed on 54 MRSA isolates obtained before and 44 MRSA isolates recovered after therapy Setting: A 120-bed Veterans Affairs nursing home care unit. Participannts: Thirty-six patients and 7 staff nurses colonized with MRSA at 1 or more sites. Intervention: Decolonization therapy with rifampin, trimethoprim-sulfamethoxazole, and clindamycin used alone or in various combinations for 5 or 10 days in conjunction with other infection control measures employed to combat the MRSA outbreak. Results: Twenty (56%) of the 36 NHCU patients were either persistently colonized or became recolonized with MRSA during tbe 30-day followup period. Positive cultures on day 3 during therapy frequently identified patients who subsequently exhibited persistent or recurrent colonization. Before therapy, 92% of MRSA isolates were susceptible to rifampin, whereas only 43% of the isolates obtained after therapy were susceptible. Sixteen (80%) of 20 patients with persistent or recurrent colonization had rifampin-resistant strains of MRSA isolated after therapy Twenty-three (18%) of 125 environmental cultures obtained during and after therapy from patients who exhibited persistent or recurrent colonization were positive for MRSA, in contrast to 9 (8%) of 107 from patients who were successfully decolonized. Conclusions: The decolonization component of the outbreak control program was judged to be ineffective and potentially hazardous because colonization persisted or recurred in more than half of the patients, and substantial antimicrobial resistance was noted in MRSA strains isolated after therapy Resistance, especially to rifampin, and possibly re-acquisition of MRSA from other human or environmental sources were 2 factors that appeared to impede the decolonization effort.
多重耐药金黄色葡萄球菌：医院感染的引入、传播和演变。
影响因子：
39.2
作者：
Locksley,RM;Cohen,ML;Quinn,TC;Tompkins,LS;Coyle,MB;Kirihara,JM;Counts,GW
通讯作者：
Counts,GW