2016-08-012024-05-14https://scholars.lib.ntu.edu.tw/handle/123456789/658929摘要：近年來國內外的監測資料皆顯示抗藥性金黃色葡萄球菌(methicillin-resistant Staphylococcusaureus, MRSA)的盛行率或發生率有逐年增加的趨勢。由於MRSA 的感染往往造成病患住院天數的延長、醫療費用的額外支出、及相關併發症與死亡率的增加，加上臨床上可用來治療MRSA 的藥物越來越有限，因此減少MRSA 的移生傳播及後續感染，無論是就病患安全或是醫療經濟效益的觀點，便成為現今抗藥性細菌管制的重點。然而以往不管是使用篩檢性培養以早期發現MRSA 移生病人並施以接觸隔離，還是針對MRSA 移生病人使用表面抗菌製劑進行去移生治療，均無法證實其效果，顯示過去控制MRSA 的介入方式有其侷限或不足之處。而最近的研究指出，MRSA 不僅只移生於病人身體表面，在腸胃道中甚至有更大量的MRSA移生菌量，而這些新的證據顯示之前的去移生治療策略之所以無法達到預期的效果，可能是因為沒有同時處理病人居家環境的染污以及廓清病人腸胃道中移生的MRSA，因而造成去移生治療的失敗。為了要達到更有效的MRSA 去移生效果，就必須跳脫以往去單用表面抗菌製劑的思維，提出全新的去移生概念-組合式根除治療(MRSA ERadication Integrated Treatment Bundle,MERIT Bundle)，亦即合併抗菌製劑進行表面去移生(surface decolonization)、服用益生菌達到腸道去移生(GI decolonization)，以及對可能遭到MRSA 汙染的居家環境進行除汙(environmentdecontamination)，以全面三度空間性的達到減少或根除MRSA 移生的加成效果。本研究為單中心、標籤公開性方式之隨機對照研究(single center, open-label, randomized,placebo-controlled study)，計畫招募300 名證實有發生MRSA 感染或移生的出院病人參與此研究，以評估組合式根除治療對於MRSA 去移生，進而減少後續發生MRSA 相關感染的效果。若經本研究證實組合式根除治療對減少MRSA 移生及後續感染的臨床效果，則將對臨床醫療及抗藥性細菌的控制產生巨大的影響，不僅完全改變現今醫療對抗藥性細菌控制的觀念與方法，更可減少整體抗生素的使用並改善MRSA 移生病人的長期預後。<br> Abstract: In recent years, microbial antibiotic susceptibility data showed that the prevalence and incidence ofmethicillin-resistant Staphylococcus aureus (MRSA) is increasing significantly both in hospital andin community environments. It has been well recognized that MRSA infections result in extendedhospital stay, the additional expenditures overall medical costs, and increased mortality andmortality of patients. Furthermore, effective antimicrobial agents available for MRSA treatment hasbecome more and more limited as the increasing drug-resistance of MRSA isolates, the treatmentand control MRSA has become a major challenge in term of patient safety perspective or diseaseburden in healthcare system globally.Previous strategies in the control of MRSA spread in hospital, including universal surveillanceculture or decolonization method using body surface antimicrobial preparations, have failed to provetheir effectiveness. It reflects the difficulty and limitation in current MRSA control interventions.Recent studies, however, showed that MRSA colonization not only in body surfaces but even higherin the patient’s gastrointestinal tract. These new evidence might explain why previous MRSAinfection control interventions failed to eradicate MRSA colonization among patients and preventthe spread of MRSA in the hospital.In the current project, we propose a novel strategy in the control for MRSA – the MRSAEradication Integrated Treatment Bundle (MERIT Bundle) – the combination of surfacedecolonization, GI decolonization and environment decontamination to eradicate MRSAcolonization and prevent subsequent infection for patients harboring MRSA. We plan to conduct anopen-label, randomized, placebo-controlled study. A total of 300 patients of microbiologicallydocumented MRSA infection of colonization will be enrolled. These enrolled patients will berandomized into intervention and controlled groups. The intervention group patients will receiveeradication bundle, which includes surface decolonization (with cholrhexidine on nasal, skin, andwound for 5 days), gastrointestinal tract decolonization (with probiotics for 28 days) andenvironmental decontamination (with bleach solution for 5 days) right before hospital discharge.The control group patients receive only education for general care and standard precaution. Allstudied patients will receive surveillance culture of nasal, axilla, groin, and stool (or anal swab)periodically after discharge from hospital. All study patients will be followed for at least one yearafter index hospitalization discharge to evaluate the occurrence of outcome events.Out study propose a novel concept and strategy and might radically change current practice infuture MRSA control policy.抗藥性金黃色葡萄球菌移生去移生治療益生菌感染防治methicillin-resistant Staphylococcus aureuscolonizationdecolonizationprobioticsinfection control