在一家大型成人囊性纤维化中心根除呼吸道耐甲氧西林金黄色葡萄球菌
Eradication of respiratory tract MRSA at a large adult cystic fibrosis centre.
作者信息
Hall H, Gadhok R, Alshafi K, Bilton D, Simmonds N J
机构信息
Adult Cystic Fibrosis Centre, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK.
Dept of Microbiology, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK.
出版信息
Respir Med. 2015 Mar;109(3):357-63. doi: 10.1016/j.rmed.2015.01.013. Epub 2015 Feb 3.
INTRODUCTION
The prevalence of MRSA in patients with CF is increasing. There is no consensus as to the optimum treatment.
METHOD
An observational cohort study of all patients with MRSA positive sputum, 2007-2012. All eradication attempts with subsequent culture results were reviewed. Single vs dual antibiotic regimens were compared for both new and chronic infections.
RESULTS
37 patients (median FEV1 58.7 (27.6-111.5)% predicted) were identified, of which 67.6% (n = 25) had newly acquired MRSA. Compared with single regimens, a high proportion of dual regimens achieved MRSA eradication (84.6% vs 50%; p = 0.1) for new infections. Rifampicin/Fusidic acid was associated with high success rates (100% vs 60% for other dual regimens (p = 0.13)). Compared with new infections, chronic MRSA was much less likely to be eradicated (18.2%, p = 0.01).
CONCLUSION
Combined antibiotic therapy, particularly Rifampicin/Fusidic acid, is a well-tolerated and effective means of eradicating MRSA in patients with cystic fibrosis.
引言
囊性纤维化（CF）患者中耐甲氧西林金黄色葡萄球菌（MRSA）的患病率正在上升。对于最佳治疗方法尚无共识。
方法
对2007年至2012年所有痰培养MRSA阳性的患者进行观察性队列研究。回顾了所有根除尝试及后续培养结果。比较了新感染和慢性感染的单药与联合抗生素治疗方案。
结果
共确定了37例患者（预测FEV1中位数为58.7（27.6 - 111.5）%），其中67.6%（n = 25）为新获得的MRSA感染。对于新感染，与单药治疗方案相比，联合治疗方案中有较高比例实现了MRSA根除（84.6%对50%；p = 0.1）。利福平/夫西地酸的成功率较高（100%，其他联合治疗方案为60%（p = 0.13））。与新感染相比，慢性MRSA感染根除的可能性要小得多（18.2%，p = 0.01）。
结论
联合抗生素治疗，尤其是利福平/夫西地酸，是根除囊性纤维化患者体内MRSA的一种耐受性良好且有效的方法。
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