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Clin Infect Dis:全家消毒可减少金黄色葡萄球菌感染

2012/01/24 来源:生物谷
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一项最新的研究表明:当一个孩子反复因金黄色葡萄球菌致皮肤或软组织感染时,全家消毒的家庭在随后几个月里再发感染的可能性远低于单独给感染儿童消毒的家庭。

金黄色葡萄球菌显微图像

目前,《临床传染病杂志》Clin Infect Dis上刊登的一项随机试验"Household Versus Individual Approaches to Eradication of Community-Associated Staphylococcus aureus in Children: A Randomized Trial"表明:当一个孩子反复因金黄色葡萄球菌致皮肤或软组织感染时,全家消毒的家庭在随后几个月里再发感染的可能性远低于单独给感染儿童消毒的家庭。

密苏里圣路易斯华盛顿大学医学院的斯蒂芬妮茨博士及其同事的新研究以183例金黄色葡萄球菌皮肤脓肿的小儿为研究对象,发现其中一半的的家庭在发生急性SSTI感染后,只要接受全家消毒者则易于康复,而另一半并不对所有家庭成员进行消毒的则不易康复。

全家消毒是一个为期5天的方案,即每日两次鼻部使用莫匹罗星和一次洗必泰清洗身体。所有参与者都得到指示,避免共用物品如毛巾或刷子,需使用液体肥皂清洁及至少每周清洗一次床单。

作者的报告指出,患儿1个月内金黄色葡萄球菌的根除率在两组研究中类似:全家消毒组为51%,个人消毒组为50%,12个月内相应的根除率为66%:54%(P=0.28)。

然而,调查发现, 家庭组一年内皮肤和软组织感染(SSTI)的发生率明显低于单人组的发生率(52%:72%;P=0.02),

此外该报告显示,在6个月内,全家消毒组中的家庭成员SSTI发病率为9%,而个人消毒组为16%(P=0.04),这种趋势在12个月的跟踪观察中仍然很明显(16%:22%,p=0.10)。

作者指出一个社区相关的金黄色葡萄球菌疫情将会影响到数百万人。“在各个家庭中,这种现实尤其具有挑战性,存在于水网系统中的金黄色葡萄球菌可能延续目前的疾病,”

“这是第一次随机试验发现全家消毒战略在减少金黄色葡萄球菌蔓延的社区环境中表现出的作用。”研究人员补充道。

研究人员表示:“但这仅仅是第一步,一个全家消毒的方法可以减少金黄色葡萄球菌的影响,但是大于50%的案例显示在家庭组中复发性为一年。”

 

Household Versus Individual Approaches to Eradication of Community-Associated Staphylococcus aureus in Children: A Randomized Trial

Stephanie A. Fritz, Patrick G. Hogan, Genevieve Hayek, Kimberly A. Eisenstein, Marcela Rodriguez, Emma K. Epplin, Jane Garbutt, and Victoria J. Fraser

Background: Community-associated Staphylococcus aureus infections often affect multiple members of a household. We compared 2 approaches to S. aureus eradication: decolonizing the entire household versus decolonizing the index case alone.

Methods: An open-label, randomized trial enrolled 183 pediatric patients (cases) with community-onset S. aureus skin abscesses and colonization of anterior nares, axillae, or inguinal folds from 2008 to 2009 at primary and tertiary centers. Participants were randomized to decolonization of the case alone (index group) or of all household members (household group). The 5-day regimen included hygiene education, twice-daily intranasal mupirocin, and daily chlorhexidine body washes. Colonization of cases and subsequent skin and soft tissue infection (SSTI) in cases and household contacts were ascertained at 1, 3, 6, and 12 months.

Results: Among 147 cases with 1-month colonization data, modified intention-to-treat analysis revealed S. aureus eradication in 50% of cases in the index group and 51% in the household group (P = 1.00). Among 126 cases completing 12-month follow-up, S. aureus was eradicated from 54% of the index group versus 66% of the household group (P = .28). Over 12 months, recurrent SSTI was reported in 72% of cases in the index group and 52% in the household group (P = .02). SSTI incidence in household contacts was significantly lower in the household versus index group during the first 6 months; this trend continued at 12 months.

Conclusions: Household decolonization was not more effective than individual decolonization in eradicating community-associated S. aureus carriage from cases. However, household decolonization reduced the incidence of subsequent SSTI in cases and their household contacts.

文献链接:http://cid.oxfordjournals.org/content/early/2011/12/22/cid.cir919

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