Antimicrobial drugs for treating methicillin-resistant Staphylococcus aureus colonization

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Abstract
Eradication strategies for methicillin‐resistant Staphylococcus aureus (MRSA) are variable. We sought to summarize the evidence for use of antimicrobial agents to eradicate MRSA. To describe the effects of topical and systemic antimicrobial agents on nasal and extra‐nasal MRSA carriage, adverse events, and incidence of subsequent MRSA infections. We searched the Cochrane Infectious Diseases Group's trials register (August 2003), the Cochrane Central Register of Controlled Trials (Issue 3, 2003), MEDLINE (1966 to 2003), EMBASE (1988 to 2003), handsearched relevant literature, and contacted MRSA experts and the manufacturer of mupirocin. Randomized controlled trials of patients colonized with MRSA comparing topical or systemic antimicrobials to placebo or no treatment, and trials comparing various combinations of topical or systemic agents to no treatment, placebo, or to topical or systemic agents. Two reviewers independently applied inclusion criteria to potentially relevant trials, assessed trial methodological quality, and extracted data. Primary outcomes included eradication of MRSA, infection due to MRSA, and adverse events. Six trials (384 participants) met the inclusion criteria. No difference in MRSA eradication was detected in four studies: one that compared mupirocin to placebo, two that compared one systemic agent to no treatment (fusidic acid in one and rifampin or minocycline in the other) and one that compared mupirocin to topical fusidic acid and oral trimethoprim‐sulfamethoxazole, examining nasal MRSA eradication as an outcome. One study compared minocycline to rifampin, with rifampicin being more effective in relation to eradication of MRSA from all sites at day 30 (relative risk 0.16; 95% confidence intervals 0.02 to 1.00), but the difference at 90 days was not statistically significant (n = 18). Two studies (one testing novobiocin and rifampin, the other ciprofloxacin and rifampin, versus trimethoprim‐sulfamethoxazole and rifampin) did not demonstrate a difference in eradication of MRSA at all sites (n = 94). Adverse events with systemic agents occurred in up to 20% of participants, however reporting was sporadic and denominators small. All trials reported development of resistance to antimicrobial agents used. There is insufficient evidence to support use of topical or systemic antimicrobial therapy for eradicating nasal or extra‐nasal MRSA. There is no demonstrated superiority of either topical or systemic therapy, or of combinations of these agents. Potentially serious adverse events and development of antimicrobial resistance can result from therapy. 以抗生素治療methicillin耐藥性金黃色葡萄球菌 根除methicillin耐藥性金黃色葡萄球菌 (MRSA) 的方法有很多。我們希望能將根除MRSA的抗生素使用證據做成摘要。 評估局部或全身性抗生素對於鼻腔帶菌或鼻腔外帶菌MRSA感染的療效、不良反應及後發的MRSA感染率。 我們搜尋了the Cochrane Infectious Diseases Group's trials register (2003年8月) 、the Cochrane Central Register of Controlled Trials (Issue 3, 2003) 、MEDLINE (1966年到2003年) 、EMBASE (1988年到2003年) ，搜尋相關文獻並和MRSA專家及mupirocin製造商連絡。 以MRSA感染的病患為樣本，以局部或全身性抗生素和安慰劑或不治療比較的隨機對照試驗，以及併用各種不同局部或全身性藥物和安慰劑、不治療或單獨使用局部或全身性藥物比較的試驗。 兩位作者分別根據收錄標準尋找相關試驗、評估方法品質並擷取數據。主要結果包括MRSA的根除、MRSA引起的感染及不良反應。 6個試驗 (384位參與者) 符合收錄標準。其中4個研究沒有找出各種MRSA根除法的差異：一個試驗比較mupirocin和安慰劑，兩個比較全身性藥物和無治療 (一個使用fusidic acid，另一個使用rifampin 或minocycline) ，還有一個試驗以mupirocin和局部fusidic acid及口服trimethoprimsulfamethoxazole比較，以鼻腔MRSA根除為結果。有一個試驗比較minocycline和rifampin，在30天後MRSA的根除方面，rifampicin似乎有較好的效果 (relative risk 0.16; 95% confidence intervals 0.02 to 1.00) ，但90天後的差異在統計學上並不顯著 (n = 18) 。兩個研究 (一個比較novobiocin和rifampin，另一個以ciprofloxacin和rifampin併用與trimethoprimsulfamethoxazole和rifampin併用比較) ，發現在所有感染部位MRSA的根除上沒有差異 (n = 94) 。有20% 的參與者，發生全身性藥物的不良反應，但都是偶而發生且共同點很少。所有的試驗都回報有抗藥性的發生。 目前沒有足夠的證據，去支持以局部或全身性抗生素根除鼻腔或鼻腔外MRSA感染。在局部、全身性治療，或併用多種藥物都沒有發現好處。抗生素治療可能導致嚴重不良反應並誘發抗藥性。 本摘要由朱奕蓁翻譯。 此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。 以抗生素治療methicillin耐藥性金黃色葡萄球菌可能導致嚴重感染。 Methicillin耐藥性金黃色葡萄球菌 (MRSA) ，是對於許多抗生素，包括penicillin有抗藥性的菌株。基於許多因素，醫院中負責感染控制的人，會希望限制MRSA的擴散，其中一個方法就是使用局部或口服抗生素，將病患體內的MRSA細菌根除。然而目前沒有足夠的證據，能支持使用局部或口服抗生素治療，去根除鼻腔或鼻腔外帶菌的MRSA。不論局部或口服給藥，或是併用多種藥物，都沒有特別有效。且抗生素治療可能導致嚴重不良反應並誘導抗藥性的產生。

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