807株流感嗜血杆菌的血清分型及耐药性的研究

目的了解南京地区儿童感染流感嗜血杆菌(Haemophilus influenza,Hi)的血清型及抗生素的耐药性。方法采集南京儿童医院2004年6月至2007年6月20 985份不同种类标本,分离鉴定Hi 807例,玻片凝集法进行血清分型,纸片扩散法(K-B法)进行抗菌药物敏感实验,E-test法测最低抑菌浓度(MIC)。结果807株流感嗜血杆菌,血清分型,不定型(NTHi)47.71%,可分型中f型最多,占可分型36.02%,b型最少,仅占可分型1.66%。K-B法检测抗生素的耐药率,氨苄西林耐药率49.07%。结论南京地区儿童感染Hi,可分型株中主要血清型以f、a型占多数。氨苄西林的耐药率逐年上升。     

广东省新兴地区儿童致病性A组链球菌emm基因测序分型的研究

目的了解新兴地区儿童感染A群链球菌（GAS）emm基因型的分布状况。方法收集本院门诊和住院的呼吸道感染、皮肤化脓感染、风湿热、猩红热患儿咽拭子和皮肤感染伤口分泌物进行培养，并采用PCR法扩增GAS的M蛋白N末端，进行测序，确定GAS的emm基因分型。结果共分离鉴定出GAS98株，GAS感染引起的咽炎、扁桃体炎、脓皮病在学龄前儿童和学龄儿童中发病率较高；98株GAS的emm基因型以emml（35．7％）、emm18（13．3％）、emm12（9．2％）多见。结论学龄前儿童和学龄儿童感染GAS发病率无年龄差异（P〉0．05）。新兴地区A群链球菌emm基因分型主导型为emml、emm18等菌型，可初步认定它们是主要流行菌株，作为合适本地的基因疫苗的基础。     

儿童咽拭子标本406份中EB病毒的检测及其基因型鉴定

目的了解湖南省株洲、湘潭和衡阳地区儿童鼻咽部EB病毒的感染状况及其基因型,为EB病毒的治疗、预防和临床检验提供指导。方法从株洲、湘潭和衡阳部分医院收集疑似EB病毒感染的儿童咽拭子标本406份,采用荧光定量聚合酶联反应（FQ—PCR）检测标本中的EB病毒-DNA;阳性标本分别用特异性引物从中扩增3个目的基因片段,其中PCR扩增的EBNA-3C片段直接电泳以分析1／2分型,BamHI片段和BamHI WI／I1交界区基因片段采用PCR-RFLP分析鉴定F／f和C／D分型,测序和Blast比对验汪分型结果。结果从406份标本中共检出 EB病毒-DNA阳性株159份,株洲74份（38．5％）,其中1型72份（97．3％）,2型2份（2．7％）;湘潭42份（38．9％）,1型40份（95．2％）,2型2份（4．8％）;衡阳43份（40．6％）,1型43份（100％）,2型未发现、从159份阳性株中随机扩增了73份做F／f分型,68份做C／D分型,共检测到F型73份,C型68份,3个地区均未检测到f型和D型。结论株洲,湘潭和衡阳儿童鼻咽部EB病毒感染的检出率分别为38．5％,38．9％,40．6％,且其主要感染的3种独立基因型以1、C、F型为主,3个地区间儿童鼻咽部EB病毒-DNA的检出率及其基因型的差异无统计学意义。     

2013-2014年三门地区儿童呼吸道流感嗜血杆菌生物分型及耐药性分析

目的：探讨三门地区儿童呼吸道流感嗜血杆菌（Hi）的生物分型及耐药性。方法：回顾性分析2013年1月至2014年12月在三门县人民医院儿科门诊与住院部治疗的呼吸道感染患儿7 140例,采用无菌负压吸引法采集新鲜痰液,进行流感嗜血杆菌培养、分离,进行生物分型,使用生物鉴定仪、鉴定卡、药敏试剂盒进行药敏试验并对其β-内酰胺酶进行检测。结果：7 140例儿童呼吸道感染患儿分离出337株Hi;生物学分型以Ⅱ型和Ⅲ型所占比例最大,二者占全部Hi菌株的91.0%;337株Hi β-内酰胺酶阳性率为32.64%（110/337）;Hi的各类抗菌药物耐药性检测中氨苄西林的耐药率最高;Hi对阿莫西林/克拉维酸、四环素、头孢噻肟、利福平、氯霉素等的敏感率均大于90%,对氧氟沙星、头孢呋辛、头孢克洛等敏感率均大于80%。结论：2013年至2014年三门地区儿童呼吸道流Hi生物学分型以Ⅱ型、Ⅲ型为主,且Ⅱ型产β-内酰胺酶的几率最高,Hi对氨苄西林的耐药率最高,对阿莫西林/克拉维酸、四环素、头孢噻肟、利福平、氯霉素等的敏感率均大于90%,阿莫西林/克拉维酸是治疗Hi感染的首选药物。     

2005—2006年烟台地区儿童肺炎链球菌、流感嗜血杆菌抗生素敏感性调查

目的：了解烟台地区儿童肺炎链球菌（Sp）、流感嗜血杆菌（Hi）对常用抗生素的敏感性。方法：对2005—2006年在烟台毓璜顶医院住院的肺炎患儿采取痰标本，采用ATB Expression自动细菌鉴定仪行痰培养；分离出Sp及Hi菌株，并行抗生素敏感性试验。结果：939例肺炎患儿分离Sp112株，Hi77株。Sp对常用抗生素耐药率为：青霉素92株（82．2％）、阿莫西林32株（28．6％）、红霉素111株（99．1％）、复方新诺明109株（97．3％）、万古霉素0株（0％）。Hi对常用抗生素耐药率为：氨苄西林36株（46．8％），复方阿莫西林8株（10．4％），头孢克洛14株（18．2％），头孢呋辛6株（7．8％），第三代头孢菌素5株（6．5％），复方新诺明69株（89．6％）。结论：烟台地区儿童Sp、Hi耐药形势严峻。Sp对青霉素、红霉素、复方新诺明等多重耐药。Hi对氨苄西林、复方新诺明耐药率高，对第三代头孢菌素、头孢呋辛、阿莫西林克拉维酸敏感性较高。     

儿童肺炎患者碳青霉烯耐药肠杆菌的临床特征分析

目的：探讨儿童肺炎碳青霉烯耐药肠杆菌耐药机制和临床传播特征,分析医院感染防控措施及经验。方法：收集江苏省徐州市中心医院2017年8月至2019年10月收治的216例儿童肺炎患者中分离的46株非重复碳青霉烯耐药肠杆菌科细菌,并进行菌株鉴定、药敏试验、基因检测、同源性、传播特征及相关临床资料分析,根据脉冲场凝胶电泳（PFGE）分型将肺炎克雷伯菌携带blaNDM-1基因的儿童肺炎患者分为A型组和非A型组,并对相关数据进行统计学分析。结果：儿童肺炎患者碳青霉烯耐药肠杆菌主要包括肺炎克雷伯菌25株（54.35%）、大肠埃希菌7株（15.22%）、阴沟肠杆菌4株（8.70%）、产酸克雷伯菌4株（8.70%）、弗劳地枸橼酸杆菌3株（6.52%）及粘质沙雷菌3株（6.52%）。碳青霉烯耐药肠杆菌对阿米卡星敏感率为86.10%,对头孢唑林、头孢他啶、头孢曲松、厄他培南、美罗培南、亚胺培南和头孢哌酮/舒巴坦耐药率分别为100.00%、100.00%、100.00%、100.00%、97.70%、95.30%及95.30%。碳青霉烯耐药肠杆菌经改良Hodge试验和乙二胺四乙酸（EDTA）协同试验阳性率分别为58.70%及36.97%,聚合酶链式反应（PCR）检测携带blaKPC-2基因者27株（58.70%）,携带blaNDM-1基因者16株（34.78%）,携带blaIMP-4基因者1株（2.17%）。13株携带碳青霉烯耐药blaNDM-1基因的肺炎克雷伯菌PFGE分型为A型7株,B型2株,C、D、E、F型各1株。A型组和非A型组患儿重症监护室（ICU）住院史和住院时间≥30 d比较差异有统计意义（P<0.05）。结论：儿童肺炎患者碳青霉烯耐药肠杆菌呈多重耐药,耐药机制主要缘于碳青霉烯酶基因克隆传播,且与患儿ICU住院史和住院时间延长有关,临床应加强医院感染防控措施以预防耐药菌传播。     

产ESBLs鲍曼不动杆菌的耐药特性、质粒谱及耐药基因型

目的了解并研究产超广谱β-内酰胺酶（ESBLs）鲍曼不动杆菌的流行、耐药特点及质粒图谱，对产ESBLs菌株进行基因分型。方法先后用nitrocefin纸棒、最低抑菌浓度（MIC）初筛法和纸片扩散确认法从临床分离的鲍曼不动杆菌中检测产ESBLs菌株，用凝胶电泳分析其质粒图谱，并用聚合酶链反应（PCR）对产ESBLs基因进行分型。结果93株鲍曼不动杆菌中，对β-内酰胺酶类抗菌药物耐药47株（79．66％），中度敏感12株（20．34％）；产ESBLs菌株有16株，占17．20％。产ESBLs鲍曼不动杆菌对头孢曲松、头孢他啶、头孢唑肟、头孢吡肟、氨曲南、庆大霉素、妥布霉素、磺胺甲曝唑、环丙沙星和阿米卡星的耐药率均显著高于非产ESBLs菌株（P〈0．05）。保留的15株产ESBLs菌具有4种质粒谱，主要为Ⅰ型和Ⅲ型；它们均携带1～2种TEM型或SHV型或PER型β-内酰胺酶基因，且80％携带OXA-23型碳青霉烯酶基因。结论产ESBLs鲍曼不动杆菌常为多重耐药菌，耐药率与产ESBLs密切相关；同一克隆株在同一病房有流行趋势；本院流行株均携带2—3种耐药基因型，主要为TEM型、PER型β-内酰胺酶基因和OXA-23型碳青霉烯酶基因。     

嗜麦芽窄食单胞菌122株耐药性及基因分型

目的确定嗜麦芽窄食单胞菌基因型与耐药模式之间的相关性,为合理使用抗生素和院内感染控制工作提供理论依据。方法用常规方法分离鉴定嗜麦芽窄食单胞菌,采用美国实验室标准化研究所制定的Kirby-Bauer纸片扩散法作体外耐药监测。分离菌株的基因分型用肠杆菌科基因间重复一致序列为引物的聚合酶链反应（ERIC-PCR）方法和脉冲凝胶电泳（PFGE）分析技术。结果122株嗜麦芽窄食单胞茵有54株（44．3％）分离自ICU病区。嗜麦芽窄食单胞菌具有多重耐药性,但是对左氧氟沙星、米诺环素耐药率相对较低。该菌对复方新诺明耐药率63．9％（78／122）,对左氧氟沙星为16．4％（20／122）,对米诺环素为1．6％（2／122）。嗜麦芽窄食单胞菌分离株有高度的基因多样性。结论与PFGE方法相比ERIC-PCR方法是一种快速、简便、经济的嗜麦芽窄食单胞菌基因分型方法。临床应加强合理利用抗生素管理,控制耐药菌的产生和医院感染的暴发流行。     

长春市金葡菌耐药状况及耐甲氧西林金葡菌基因分型

目的调查长春地区临床分离金葡菌的耐药状况及Panton—Valentine杀白细胞素（PVL）分布情况；确定耐甲氧西林金葡菌（MRSA）染色体及葡萄球菌me~盒式染色体（SCCmec）基因分型。方法琼脂稀释法测定苯唑西林等17种抗菌药物对2004年6月～2005年1月长春市3家教学医院临床标本分离的83株金葡菌的最低抑菌浓度（MIC）；聚合酶链式反应（PCR）进行金葡菌的PVL基因检测；脉冲场凝胶电泳（PFGE）对MRSA菌株作染色体同源性分析。多重PCR方法检测MRSA的SCCmec基因分型。结果83株金葡菌中MRSA12株（占14．5％）；金葡菌PVL的基因阳性7株（占8．4％）。MRSA对β-内酰胺类、红霉素、克林霉素、庆大霉素、四环素、氟喹诺酮类耐药率均超过90％，对氯霉素、利福平耐药率分别为8．3％、58．3％。未发现对糖肽类及复方磺胺甲嗯唑耐药的MRSA。甲氧西林敏感金葡菌（MSSA）对青霉素G、红霉素、克林霉素、四环素、庆大霉素耐药率分别为95．8％、67．6％、49．3％、45．1％、26．8％，对头孢菌素、氯霉素、利福平、氟喹诺酮类、复方磺胺甲曙唑耐药率均低于20％。MRSA的PFGE显示为A、B两种类型，以A型为主，占92％（11／12），三家医院均有分布。MRSA的SCCmec分型．Ⅲ型为主75％（9／12）。结论长春市MRSA发生率低于国内报道平均水平；MRSA为两种不同类型克隆株，在不同医院间存在克隆传播；未发现社区获得性MRSA菌株。     

我国婴幼儿腹泻轮状病毒分型研究

轮状病毒是在世界范围内引起婴幼儿腹泻的主要病原之一。根据病毒外壳蛋白VP4和VP7抗原性的不同可区分为不同型，P（VP4，Prtoease sensitive)型和G（VP7，Glycoprotein)型。本实验从中国8个地区（长春，秦皇岛，北京，杭州，福州，广州，成都, 昆明）的急性腹泻患儿中收集到1093份非菌性腹泻标本。标本经病毒dsRNA聚丙烯酰胺凝胶电泳（PAGE）和酶联免疫吸附试验（ELISA）检测A组轮状病毒（HRV）。结果阳性标本为432份（39．5％），电泳型长型占优势，占PAGE阳性总数的96％以上，阳性标本利用血清型特异的单克隆抗体ELISA进行分型，结果表明我国上述8个地区1998－1999年轮状病毒流行季节中A组轮 病毒以G1型为主要流行株，占阳性总数的80．3％，其次为G2（11．1％），G4（3．9％）和G2（3．2％），有发现G9型，在本实验中共有18（4．17％）份阳性标本有用有单克隆体和型特异性引物无法分型，12（2．78％），份标本为混合感染，这与相关的报道一致。本实验中抽样选取了119份G分型阳性标本进行VP4分型，其中P[8]型有21份（17．6％）P[4]型有13份（10．9）,P[6]型有12份（10．1％），P[9]型有8份（6．7％），与相关的报道基本一致，另外65份（54．6％）用现有引物无法分出P型，A组轮状病毒G型和P型的关系常见P[8]G1和P[4]G2，本实验中轮状病毒中分离株作了常见的P[8]G1(28.3%)，P[4]G2(9.4%)型外，还检测到P[8]G3(5.7%),P[8]G4(3.7%)和其它较少见的基因型，65份未分出P型的标本其中49份有一次扩增的产物，提示可能为其它P型，有待进一步的检定。以上结果，结合文献资料分析可为我国轮状病毒疫苗的应用和开发提供一个清晰的流行病学背景资料。     

不可分型流感嗜血杆菌蛋白D研究进展

流感嗜血杆菌(Haemophilus influenzae,Hi)蛋白D(Protein D,PD)是高度保守的表面脂蛋白,相对分子质量42 000,存在于所有的可分型Hi和不可分型Hi(nontypeable Haemophilus influenzae,NTHi)中,是一种具有甘油磷酸二酯酶活性的细菌毒力因子,能导致宿主上皮细胞释放磷酸胆碱,在Hi引起呼吸道感染过程中起重要作用.以NTHi PD作为载体蛋白的肺炎链球菌多糖结合疫苗,不但能预防肺炎链球菌性耳炎,而且对NTHi引起的急性中耳炎也具有预防作用.PD是迄今为止第一种能在人类机体中诱导保护性应答的NTHi抗原,也是最具潜力的多糖结合疫苗候选载体蛋白.     

某市健康学龄前儿童咽部定植菌携带及耐药分析

目的 调查健康学龄前儿童咽部定植菌携带情况及药敏结果，为临床合理用药提供理论依据。方法 采集市区某公立幼儿园首次入托的119名健康学龄前儿童咽拭子标本进行细菌培养，分析定植菌携带情况及耐药性结果。 结果 119名健康学龄前儿童咽部定植菌种类最多5种，最少0种，平均(3.36±0.79)种。其中108名儿童半定量培养分离出中等量(++)以上细菌菌株135株，主要为草绿色链球菌、卡他莫拉菌、肺炎链球菌、金黄色葡萄球菌、流感嗜血菌。药敏试验显示常见细菌对红霉素、四环素、复方磺胺甲噁唑、克林霉素等临床常用抗生素均有较高的耐药率。结论 本地区健康学龄前儿童咽部定植菌以条件致病菌为主，多数为多种菌混合定植，对临床常用抗生素均有较高耐药性，规范儿童上呼吸道感染抗生素的使用至关重要。     

某区甲型H1N1流感病毒分离鉴定及同源性的分析

目的检测并分离甲型H1N1流感病毒,对开封地区首次分离到的病毒株进行全基因组序列测定及同源性分析,为研究流感病毒的流行及变异规律提供科学依据。方法采用Real-time RT-PCR方法检测,筛选确定出甲型H1N1流感病毒阳性标本;利用狗肾传代细胞分离得到甲型H1N1流感病毒株A/Kaifeng/01/2009(H1N1);测定并分析其全基因组序列;利用序列比对进行了同源性分析。结果从1828份流感样病例中检出甲型H1N1流感病毒阳性标本286份,阳性率15.6%。在开封地区首次获得甲型H1N1流感病毒株及全基因组序列。基因组序列分析表明:该毒株与2009年大流行株高度同源,为同一进化分支。与以往流行的猪流感病毒株对比发现,HA基因有12个碱基发生了点突变。结论 MDCK细胞对甲型H1N1流感病毒具有较高敏感性;开封地区首例甲型H1N1流感病例分离病毒株与北美流行株高度同源;相对于以往古典型猪流感代表株出现了HA蛋白抗原性漂移;为今后进一步开展甲型H1N1流感病毒分子生物学研究奠定基础。     

Pharyngeal viral population in 3- to 6-year-old children before and after influenza immunization using the NIVGRIP vaccine administered orally

Immunofluorescence techniques were used to investigate the incidence of viral antigens in exfoliated pharyngeal cells collected from 94 3-6-year-old children living in a collectivity, vaccinated by oral route with NIVGRIP inactivated influenza vaccine. The vaccination resulted in a significant decrease of IF-positive subjects from 80% before to 39% after immunization, indicating a fall in the virus carriage level. The percentage of children in which two or more viral antigens were found also decreased from 72% to 33%. As regards the incidence of different viruses, the complete disappearance of influenza antigens and a marked decrease of the other investigated viral agents were recorded.     

泰利霉素经 AP-1途径抑制不可分型流感嗜血杆菌诱导的 MUC5AC表达

目的：研究大环内酯类抗生素泰利霉素（telithromycin,TEL）对不可分型流感嗜血杆菌（nontypeable haemophilus influenzae,NTHi）诱导气道上皮细胞表达黏蛋白MUC5AC的影响,并探讨其可能的分子机制。方法：体外培养NCI-H292细胞,用10mg／LTEL孵育6h预处理细胞,随后加入不同浓度NTHi孵育3～9h,分别采用ELISA和实时定量PCR检测MUC5AC蛋白和mRNA的表达情况,ELISA检测NCI-H292细胞内NF-KB和活化蛋白（Activa-torprotein-1,AP-1）DNA结合活性。结果：NT-Hi能明显诱导NCI-H292细胞产生和表达MUC5AC,并能激活NF-IcB和AP-1。而TEL处理后,能明显抑制NTHi诱导的MUC5AC蛋白和mRNA表达,并有效抑制AP-1的DNA结合活性,但对N1a-KB活性无明显影响。结论：TEL能抑制NTHi诱导的黏蛋白表达,其机制可能与抑制AP-1DNA结合活性有关。     

Antimicrobial susceptibility of nasopharyngeal isolates of Haemophilus influenzae from healthy children in day-care centres: results of multicentre study in Russia.

Resistance of Haemophilus influenzae from clinical isolates can be predicted on the basis of results of antimicrobial susceptibility of nasopharyngeal isolates. The carriage rate and the antimicrobial susceptibility of H. influenzae isolated in healthy children attending day-care centres in Moscow, Smolensk and Yartsevo was studied. The susceptibility of ampicillin, amoxycillin/clavulanate, cefaclor, erythromycin, roxithromycin, clarithromycin and trimethoprim-sulphamethoxazole were determined by the E-test. The mean carriage rate of H. influenzae was 44%. Resistance of H. influenzae to ampicillin was 2.3%, to amoxycillin/clavulanate 0.7%, to cefaclor 0.7%, to clarithromycin 18.7% and to trimethoprim-sulphamethoxazole 21%. These included strains that showed intermediate-resistance. The antimicrobial resistance profiles varied in different centres. The clinical use of trimethoprim-sulphamethoxazole should be restricted because of the high resistance of H. influenzae to antifolate compounds.     

Haemophilus influenzae vaccine candidate outer membrane protein P6 is not conserved in all strains

An outer membrane protein of nontypeable Haemophilus influenzae (NTHi), P6, is a vaccine candidate because it has been characterized as conserved among all H. influenzae strains. Among 151 isolates from children, age 6 to 30 months, evaluating NTHi nasopharyngeal (NP) and oropharyngeal (OP) colonization and tympanocentesis confirmed acute otitis media we identified 14 strains (9.3%) that had variant protein sequences of P6. One atypical omp P6 isolate had sequence mutations in the binding site of a proposed major antigenic epitope of omp P6 identified by monoclonal antibody 7F3. Eight strains (5.3%) had non-homologous variations in amino acids that could result in significant changes to the protein structure of P6, and 5 other strains had amino acid substitutions at four previously described key residue sites. These results show that NTHi omp P6 is not invariant in its structure among respiratory isolates from children.     

Clinical study on cefprozil in pediatrics]

Clinical efficacy and safety of cefprozil (CFPZ, BMY-28100), a newly developed oral cephalosporin, were studied in our pediatric department. Clinical effectiveness, bacteriological effectiveness and side effects were studied in 116 pediatric patients with ages ranging 4 months to 11 years. CFPZ was given 4.6-14.1 mg/kg daily in 3 times for 3-10 days. Clinical efficacies were evaluated in 112 patients, and the therapeutic effectiveness were excellent in 1 and good in 6 for 7 patients with acute pharyngitis, excellent in 24 and good in 26 for acute purulent tonsillitis, excellent in 3, good in 8 and fair in 1 for acute bronchitis, excellent in 21, good in 7, fair in 1 and poor in 1 for acute pneumonia, excellent in 1 acute purulent parotitis, excellent in 2 and good in 7 for acute UTI, good in 1 impetigo, fair in 1 periproctal abscess and good in 1 acute enteritis. The effectiveness rate was 96.4%. Bacteriologically, 4 strains of Staphylococcus aureus (beta-lactamase producing strains), 1 strain of Staphylococcus epidermidis (beta-lactamase producing strain), 2 strains of Streptococcus pneumoniae, 2 strains of Streptococcus agalactiae, 4 strains of beta-Streptococcus, 1 strain of Klebsiella pneumoniae (beta-lactamase producing strain) and 1 strain of Salmonella C2 were all disappeared, and of 22 strains of Streptococcus pyogenes, 20 strains were disappeared, 1 was decreased and 1 was unknown, of 5 strains of Escherichia coli (3 beta-lactamase producing strains), 4 were disappeared and 1 was decreased, of 29 strains of Haemophilus influenzae (14 beta-lactamase producing strains), 14 were disappeared, 11 were decreased, 3 persisted and 1 was unknown and of 2 strains of Haemophilus parainfluenzae (1 beta-lactamase producing strain), 1 was disappeared and 1 persisted. The bacteriological eradication rates for Gram-positive bacteria and Gram-negative bacteria were 97.1% and 56.8%, respectively, and the drug was especially effective against Gram-positive bacteria. No side effects nor refusal of ingestion were observed. As abnormalities in laboratory test results, 3 cases of elevation of eosinophil counts and 1 of elevation of platelet counts were observed. In conclusion, CFPZ was considered to be a safe and highly effective antibiotic in pediatric infections.     

Eradication of methicillin-resistant Staphylococcus aureus (MRSA) throat carriage: a randomised trial comparing topical treatment with rifampicin-based systemic therapy

Eradication of methicillin-resistant Staphylococcus aureus (MRSA) colonisation may prevent transmission of strains between patients and reduces the risk of clinical infection. Colonisation of the throat is associated with prolonged carriage and is more difficult to eradicate. An open randomised study was conducted to evaluate two eradication protocols. Patients with pharyngeal carriage of MRSA were enrolled at six Swedish centres during 4 years. One treatment group received oral rifampicin and either clindamycin or trimethoprim/sulfamethoxazole (SXT) for 7 days in combination with nasal mupirocin. Patients in the other group were treated with nasal mupirocin only. Patients in the same household were randomised together. Both groups followed a hygiene protocol including chlorhexidine washing. Cultures from the nares, perineum and throat were taken at baseline and then at 2 weeks, 2 months and 6 months after the end of treatment. A total of 28 patients received rifampicin-based systemic antibiotics and 24 subjects received mupirocin only. At follow-up 6 months after the end of treatment, 61% of patients and 50% of households in the systemic antibiotics group had culture results negative for MRSA. Significantly less patients (12%) and households (10%) became decolonised in the group receiving topical treatment only. A combination of rifampicin and either clindamycin or SXT was more effective in eliminating pharyngeal MRSA carriage compared with topical treatment with mupirocin only.