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首页> 外文期刊>Infection >A holistic approach to MRSA eradication in critically ill patients with MRSA pneumonia.
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A holistic approach to MRSA eradication in critically ill patients with MRSA pneumonia.

机译：重症MRSA肺炎患者中MRSA根除的整体方法。

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BACKGROUND: The number of Methicillin-resistant Staphylococcus aureus (MRSA) pneumonia cases is increasing in many European countries. In this observational study in one medical and three surgical ICUs multiple interventions for the treatment and eradication of nosocomial MRSA-pneumonia were used. PATIENTS AND METHODS: Twenty-one critically ill patients (age: 59 +/- 14 years, 15 males/6 females, 18 ventilator-associated, 3 nosocomial, clinical pulmonary infection score > 6 in all patients, APACHE II 18 +/- 5) were enrolled. The patients were treated with a 7-day course of iv linezolid (600 mg bid) plus rifampicin (600 mg bid), endotracheal vancomycin 100 mg qid, thrice daily mouth and throat washing with chlorhexidine 1% fluid and nasal mupirocin ointment, twice daily skin and hair washings with chlorhexidine gluconate 4% and tracheostomy (n = 8) wound care with povidone-iodine spray. Control samples (endotracheal secretions, nose, wound, and pharyngeal swabs) were taken 2, 3, 4, 7 days and 2 months thereafter. Multilobular pneumonia was seen in 16, pleural effusion in 12, and MRSA bacteremia in 4 patients. RESULTS: One patient died during the follow-up period due to cerebral bleeding. In the remaining 20 patients, pneumonia was clinically cured in all patients and all patients were free of MRSA after eradication. Six patients died due to myocardial infarction (n = 3), gramnegative septic shock (n = 2), herpes encephalitis (n = 1) > 7 days after eradication. No MRSA reinfection occurred during the control period. CONCLUSION: We conclude that in patients with MRSA pneumonia an approach using a 7-day course of intravenous linezolid plus rifampicin, intratracheal vancomycin, nasal mupirocin, cutaneous and oropharyngeal chlorhexidin plus povidone-iodine cures pneumonia and is effective for MRSA eradication.
机译：背景：在许多欧洲国家，耐甲氧西林金黄色葡萄球菌（MRSA）肺炎的病例数量正在增加。在一项观察性研究中，在一个医疗ICU和三个外科ICU中，使用了多种干预措施来治疗和根除医院内MRSA-肺炎。患者与方法：21名重症患者（年龄：59 +/- 14岁，男15例，女6例，呼吸机相关18例，医院内3例，临床肺部感染评分均在所有患者中均≥6，APACHE II 18 +/- 5）被录取了。患者接受静脉注射利奈唑胺（600毫克出价），利福平（600毫克出价），气管内万古霉素100毫克qid的7天疗程，每天三次，用1％的洗必泰洗液和咽喉冲洗，每天两次鼻饲莫匹罗星软膏葡萄糖酸氯己定4％清洗皮肤和头发，并用聚维酮碘喷雾进行气管切开术（n = 8）伤口护理。此后2、3、4、7天和2个月采集对照样品（气管内分泌物，鼻子，伤口和咽拭子）。多叶性肺炎16例，胸腔积液12例，MRSA菌血症4例。结果：一名患者在随访期间因脑出血死亡。在其余20例患者中，所有患者的肺炎均已临床治愈，所有患者在根除后均无MRSA。根除后7天，有6例患者死于心肌梗死（n = 3），革兰氏阴性脓毒性休克（n = 2），疱疹性脑炎（n = 1）。在对照期内未发生MRSA再感染。结论：我们得出结论，在MRSA肺炎患者中，采用静脉使用利奈唑胺加利福平，气管内万古霉素，鼻腔莫匹罗星，皮肤和口咽洗必泰加聚维酮碘加7天疗程的方法可治愈肺炎，并且可有效根除MRSA。

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