MRSA感染的治疗

1961年首次发现耐甲氧西林金黄色葡萄球菌（methicillin-resistant staphylococcus aureus,MRSA）引起的感染[1].40年来,由于抗生素尤其是广谱抗生素的滥用,MRSA造成的院内与院外感染均成上升趋势.2008年中国细菌耐药性监测协作网（CHINET）监测结果显示,国内主要地区12所教学医院MRSA平均检出率为55.9%,最高为77.5%[2],属MRSA感染的严重国家之一.     

MRSA鼻腔筛查可排除MRSA手术部位感染：一项诊断实验meta分析

目的评价耐甲氧西林金黄色葡萄球菌（MRSA）鼻腔筛查对于MRSA手术部位感染的诊断价值。 方法检索PubMed、EMBASE、中国知网和万方数据库中,有关MRSA鼻腔筛查与MRSA手术部位感染的文献。纳入文献时间从数据库建立到2019年3月。使用诊断实验质量评价表（QUADAS-2）进行质量评价。采用STATA软件进行分析,结局指标为灵敏度、特异度、阳性似然比、阴性似然比、阳性预测值和阴性预测值。 结果最终纳入10篇文献,共39 831名患者。MRSA鼻腔筛查对于诊断及预测MRSA手术部位感染的灵敏度为37%（95% CI：27%,48%）、特异度为95%（95% CI：94%,96%）。阳性似然比为7.98（95% CI：6.37,10.0）,阴性似然比为0.66（95% CI：0.57,0.77）,阳性预测值为9.6%,阴性预测值为99.3%,DOR为12.0（95% CI：8.62,16.8）。异质性来源于MRSA筛查时使用的鉴定方法（PCR法/细菌培养法）。Deeks漏斗图显示,纳入研究不存在发表偏倚。 结论MRSA鼻腔筛查对于筛查MRSA手术部位感染具有较高的特异度和阴性预测值,可用于排除MRSA肺炎,患者鼻腔未定植MRSA,则发展为MRSA手术部位感染的可能性较小。所以,MRSA鼻腔筛查可作为规范抗菌药物经验性用药的一种有效管理工具,尤其可用于减少无鼻腔定植者的经验性治疗。     

老年呼吸监护病房MRSA感染病人的护理

对6例耐甲氧西林葡萄球菌（MRSA）感染病人进行治疗和护理，结果5例MRSA病人痰培养相继转为阴性，1例因心力衰竭死亡，提示加强医务人员的预防意识、严格洗手和消毒隔离制度，合理应用抗生素，可有效控制MRSA流行。     

1例肌萎缩侧索硬化症并发MRSA感染患者的护理

总结1例肌萎缩侧索硬化症并发耐甲氧西林金黄色葡萄球菌(MRSA)感染患者的护理。护理要点为:加强基础护理,密切观察生命体征和病情变化,维持有效的机械通气,保证足够的营养支持;监测细菌培养结果,严格落实消毒隔离措施,预防导管相关感染的发生;注意抗生素的合理使用和用药反应。44d后解除患者MRSA感染隔离。     

1例压疮伴MRSA感染患者的护理

对1例Ⅱ期压疮伴耐甲氧西林金黄色葡萄球菌(MRSA)感染患者在全身抗感染、对症支持治疗的基础上应用陈氏改进型玉红膏治疗局部创面.结果创面换药12 d愈合,细菌培养未见MRSA,住院30 d病情好转.提出加强创面护理使中药发挥最大作用,加强病室消毒管理,防止交叉感染,加强饮食营养指导和心理护理是促进创面愈合的关键.     

1例压疮伴MRSA感染患者的护理

对1例Ⅱ期压疮伴耐甲氧西林金黄色葡萄球菌（MRSA）感染患者在全身抗感染、对症支持治疗的基础上应用陈氏改进型玉红膏治疗局部创面。结果创面换药12d愈合,细菌培养未见MRSA,住院30d病情好转。提出加强创面护理使中药发挥最大作用,加强病室消毒管理,防止交叉感染,加强饮食营养指导和心理护理是促进创面愈合的关键。     

2008~2010年某院金黄色葡萄球菌感染现状及耐药性变迁分析

目的 了解本院院内金黄色葡萄球菌的临床分布及耐药性变迁,为临床合理使用抗菌药物提供一定的依据.方法 收集分离自2008年1月至2010年12月本院住院患者金黄色葡萄球菌共859株,采用 VITEK-2 Compact 进行鉴定,采用K-B纸片扩散法进行药敏试验,头孢西丁纸片扩散法鉴定耐甲氧西林金黄色葡萄球菌(MRSA),采用双纸片扩散法检测诱导型克林霉素耐药情况,应用WHONET 5.4软件进行数据处理.结果 本研究共检出金黄色葡萄球菌859株,主要分离自痰液524株(61.0%),伤口分泌物153株(17.8%);科室分布情况为:呼吸内科291株(33.9%),肿瘤科157株(18.3%),神经内科133株(15.5%).本研究所分离菌株中MRSA共253株(29.5%),诱导型克林霉素检测阳性菌155株(49.1%).MRSA检出率逐年升高,MRSA对16 种抗菌药物的耐药率均高于甲氧西林敏感金黄色葡萄球菌(MSSA),其中三者对头孢唑啉、头孢呋辛、环丙沙星、左氧氟沙星和利福平的耐药率比较,差异具有统计学意义(P< 0.05),未检出耐万古霉素和利奈唑胺菌株.结论临床中应根据病原学药敏结果合理选择抗菌药物,减少因抗菌药物滥用而导致的耐药菌株的产生.     

耐甲氧西林金黄色葡萄球菌感染的四肢创伤性骨髓炎的手术治疗

目的:总结并探讨采用利奈唑胺静滴联合万古霉素局部靶向缓释治疗耐甲氧西林金黄色葡萄球菌(dumethicillin-resistant Staphylococcus aureus,MRSA)感染的四肢创伤性骨髓炎的临床疗效及应用价值.方法:回顾分析2015年3月至2017年3月在我院就诊的MRSA感染的四肢创伤性骨髓炎3...     

莫匹罗星对烧伤创面金黄色葡萄球菌感染的治疗

应用2%莫匹罗星软膏(实验组)及磺胺嘧啶银(对照组)治疗41例平均面积2.1%±1.12%的金黄色葡萄球菌感染创面,结果表明:试验组总有效率为88.9%,创面细菌清除率为96.3%,金葡菌清除率高达88.8%;而 SD-Ag 对照组依次分别为45%、70%及40%。从烧伤创面分离的金葡菌对多种抗生药物的敏感试验表明,对莫匹罗星敏感率为92.68%,仅低于万古霉素而高于头孢噻吩、亚胺硫霉素、环丙氟哌酸等,差异有显著意义。莫匹罗星对金葡菌的 MIC_(50)≤0.25 mg/L、MIC_(90)≤4 mg/L,(MIC范围0.25～256mg/L)。提示莫匹罗星软膏可作为烧伤创面金葡菌感染的首选药物。     

The Effect of G-CSF in an Experimental MRSA Graft Infection in Mice

Wound infection after prosthetic material implantation is a troublesome complication with an incidence of 2% to 10%. The effect of granulocyte colony-stimulating factor (G-CSF) was studied in an experimental methicillin-resistant Staphylococcus aureus (MRSA) graft infection model. Eighty adult mice were used. Under general anesthesia an abdominal incision of 2 cm in length was performed. A subcutaneous cavity of 2 × 2 cm in size was created. Polypropylene mesh pieces of 2 × 1 cm and MRSA solution of 0.1ml of 10⁸ CFU/mL were used. G-CSF was applied systemically or locally in a dosage of 0.02 MU/30 g body weight. There were 8 groups: group I, wound + MRSA; group II, wound + mesh + MRSA; group III, wound + mesh + MRSA + G-CSF (ip, 48 h before operation); group IV, wound + mesh + MRSA + G-CSF (ip, 24 h before operation); group V, wound + mesh + MRSA + G-CSF (locally, into the cavity); group VI, wound + mesh (incubated in G-CSF solution for 4 h) + MRSA; group VII, wound + mesh + MRSA + G-CSF, ip, 24 h from operation; and group VIII (positive control group), wound + mesh + MRSA + Teicoplanin (0.03 mg/30 g body weight, ip, 1/2 h before operation). Three days after, animals were killed and incisions were examined for possible infection or abscess formation and wound failure. Meshes were removed; after vortexing and dilution, samples were incubated with 5% agar media. Results of bacterial incubation were evaluated 24 h and 48 h later. There were symptoms of wound infection and abscess formation in all groups except group VIII. In group VIII, MRSA was isolated in 7 events with a colony count below 10³. Bacterial counts were above 10⁶ (10⁶–10⁸) in all other groups. Thus, it was observed that wound infection could be created with this model, but G-CSF could not prevent the development of wound infection, whether it was administered systemically or locally. Teicoplanin decreased the number of colony-forming units of MRSA, and prevents wound infection in this MRSA wound infection model.     

The Impact of MRSA Colonization on Surgical Site Infection Following Major Gastrointestinal Surgery

Purpose

The purpose of this study is to determine whether methicillin-resistant Staphylococcus aureus (MRSA) colonization affects surgical site infections (SSI) after major gastrointestinal (GI) operations.

Methods

We retrospectively reviewed the charts of all patients undergoing major GI surgery from December 2007 to August 2009. All patients were tested for MRSA colonization and grouped according to results (MRSA+, methicillin-sensitive S. aureus [MSSA]+, and negative). Data analyzed included demographics, incidence of SSI, and wound culture results.

Results

A total of 1,137 patients were identified; 78.9 % negative, 14.7 % MSSA+, and 6.4 % MRSA+. The mean age was 59.5 years, 44.5 % of the patients were men, and 47.9 % of the patients underwent colorectal operation. SSI was identified in 101 (8.9 %) patients and was higher in the MRSA+ group than the negative and MSSA+ groups (13.7 vs. 9.4 vs. 4.2 %; p?<?0.05). Although MRSA colonization had an odds ratio of 1.43 for developing an SSI, it was not a significant independent risk factor. However, the MRSA+ group was strongly associated with MRSA cultured from the wound when SSI was present (70 vs. 8.5 %; p?<?0.0001).

Conclusions

MRSA colonization is not an independent risk factor for SSI following major GI operations; however, it is strongly predictive of MRSA-associated SSI in these patients. Preoperative MRSA nasal swab test with decolonization may reduce the incidence of MRSA-associated SSI after major GI surgery.     

An Audit Demonstrating a Reduction in MRSA Infection in a Specialised Vascular Unit Resulting from a Change in Infection Control Protocol

INTRODUCTION: In 2003, 18% of all admissions to our vascular ward were colonised by MRSA, with an MRSA infection rate of 10.6%. Standard practice was to segregate patients with proven MRSA from the rest of the patient pool. After a prospective audit, regression analysis was used to identify factors that could stratify patients into high and low risk for MRSA colonisation. A change in isolation policy was introduced that segregated patients according to their risk of MRSA acquisition, and isolated all patients undergoing prosthetic vascular reconstruction. Antibiotic policy was also altered. This audit reports the impact of these changes on MRSA colonisation and infection rates. METHODS: The MRSA status of patients during 777 in-patient episodes was prospectively recorded during three time spans; period 1 (November 2002-April 2003) before the change in isolation and antibiotic policy and, periods 2 (August-December 2003) and 3 (October 2004-January 2005) after the change in policy. RESULTS: Hospital acquired MRSA colonisation was reduced from 10.6% in period 1, to 1.1 and 1.4% in periods 2 and 3, respectively (p<0.001). Similarly, MRSA infection rates fell from 10.6 to 2.9 and 0.9% over the same time frame (p<0.001). The most dramatic changes in MRSA infection rates occurred in patients undergoing aneurysm repair (MRSA infection 30.1% in period 1 vs. 3.9 and 2.9% in periods 2 and 3) and lower limb revascularization (31 vs. 0 vs. 4.2%). Stepwise regression analysis revealed that the system of isolation was a significant factor reducing MRSA infection and colonisation rates (p<0.001). CONCLUSIONS: These data demonstrate that a change in infection control policy can significantly reduce MRSA infection in a vascular unit.     

Treatment for Aortic Graft Infection

Nine patients with an aortic graft infection presented after undergoing aortic grafting. Seven of 9 patients underwent an initial aortic reconstruction in our hospital. The incidence of aortic graft infection was 1.5% (7/456). There were 6 cases of paraprosthetic infection and 3 cases of aortointestinal fistulas. The treatments consisted of a complete graft excision and an axillofemoral bypass in 6 patients, a complete graft excision alone, a partial graft excision and a femorofemoral bypass, and the preservation of the graft with omental wrapping and irrigation in 1 each. Broad-spectrum antibiotics were intravenously administered to all patients and were then replaced by selective antibiotics for the responsible organisms. All surviving patients received antibiotics orally for 3–6 months. The early postoperative mortality rate was 11.1%. Aortoduodenal fistula occurred in 1 patient with graft excision alone. Graft thrombosis occurred in 2 patients with an axillofemoral bypass. No late graft infection or stump blowout occurred in any patient. We believe that a complete excision of the infected graft as well as the maintenance of distal tissue perfusion is necessary. However, based on the condition of the patient, the appearance of the operating field, and the difficulty of a repeat operation, we would like to stress the importance of selecting the best and safest treatment plan for each case. Received: August 26, 1999 / Accepted: July 25, 2000