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Ubat‐ubatan antimikrobial untuk merawat pertumbuhan Staphylococcus aureus berkesan dengan methicillin dan tahan methicillin

Abstract

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Background

Eradication strategies for methicillin‐resistant Staphylococcus aureus (MRSA) are variable. We sought to summarize the evidence for use of antimicrobial agents to eradicate MRSA.

Objectives

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.

Search methods

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.

Selection criteria

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.

Data collection and analysis

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.

Main results

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.

Authors' conclusions

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.

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Plain language summary

Ubat‐ubatan antimikrobial untuk merawat pertumbuhan Staphylococcus aureus tahan methicillin

Staphylococcus aureus adalah bakteria yang boleh menyebabkan jangkitan yang serius. S. aureus tahan methicillin (MRSA) merujuk kepada strain S. aureus yang tahan banyak antibiotik yang termasuk penicillin. Kakitangan kawalan jangkitan Hospital mahu menghadkan penyebaran MRSA kerana beberapa sebab dan salah satu cara untuk berbuat demikian adalah dengan menggunakan ubat‐ubatan antimikrobial secara topikal atau lisan dalam usaha untuk membasmi MRSA daripada individu‐individu yang dijangkiti. Walau bagaimanapun, tidak terdapat bukti mencukupi untuk menyokong penggunaan terapi antimikrobial secara topikal atau lisan untuk membasmi MRSA pada hidung atau extra‐nasal. Tidak ada satu jenis rawatan secara topikal atau lisan atau dengan kombinasi kedua‐duanya menunjukkan kesan yang yang lebih bagus. Peristiwa yang berpotensi serius dan kejadian rintangan antimikrob boleh disebabkan oleh terapi.