目前,，《臨床傳染病雜志》Clin Infect Dis上刊登的一項(xiàng)隨機(jī)試驗(yàn)"Household Versus Individual Approaches to Eradication of Community-Associated Staphylococcus aureus in Children: A Randomized Trial"表明：當(dāng)一個(gè)孩子反復(fù)因金黃色葡萄球菌致皮膚或軟組織感染時(shí),，全家消毒的家庭在隨后幾個(gè)月里再發(fā)感染的可能性遠(yuǎn)低于單獨(dú)給感染兒童消毒的家庭。
密蘇里圣路易斯華盛頓大學(xué)醫(yī)學(xué)院的斯蒂芬妮茨博士及其同事的新研究以183例金黃色葡萄球菌皮膚膿腫的小兒為研究對(duì)象,，發(fā)現(xiàn)其中一半的的家庭在發(fā)生急性SSTI感染后,，只要接受全家消毒者則易于康復(fù)，而另一半并不對(duì)所有家庭成員進(jìn)行消毒的則不易康復(fù),。
全家消毒是一個(gè)為期5天的方案,即每日兩次鼻部使用莫匹羅星和一次洗必泰清洗身體,。所有參與者都得到指示，避免共用物品如毛巾或刷子,，需使用液體肥皂清潔及至少每周清洗一次床單,。
作者的報(bào)告指出,患兒1個(gè)月內(nèi)金黃色葡萄球菌的根除率在兩組研究中類似：全家消毒組為51%，個(gè)人消毒組為50%,，12個(gè)月內(nèi)相應(yīng)的根除率為66%：54%（P=0.28）,。
然而,，調(diào)查發(fā)現(xiàn), 家庭組一年內(nèi)皮膚和軟組織感染（SSTI）的發(fā)生率明顯低于單人組的發(fā)生率（52%:72%；P=0.02）,，
此外該報(bào)告顯示,，在6個(gè)月內(nèi)，全家消毒組中的家庭成員SSTI發(fā)病率為9%,，而個(gè)人消毒組為16%（P=0.04）,，這種趨勢(shì)在12個(gè)月的跟蹤觀察中仍然很明顯（16%：22%，p=0.10）,。
作者指出一個(gè)社區(qū)相關(guān)的金黃色葡萄球菌疫情將會(huì)影響到數(shù)百萬(wàn)人,。“在各個(gè)家庭中，這種現(xiàn)實(shí)尤其具有挑戰(zhàn)性,，存在于水網(wǎng)系統(tǒng)中的金黃色葡萄球菌可能延續(xù)目前的疾病,，”
“這是第一次隨機(jī)試驗(yàn)發(fā)現(xiàn)全家消毒戰(zhàn)略在減少金黃色葡萄球菌蔓延的社區(qū)環(huán)境中表現(xiàn)出的作用。”研究人員補(bǔ)充道,。
研究人員表示：“但這僅僅是第一步,，一個(gè)全家消毒的方法可以減少金黃色葡萄球菌的影響，但是大于50%的案例顯示在家庭組中復(fù)發(fā)性為一年,。”（生物谷Bioon.com）
doi:10.1093/cid/cir919
PMC:
PMID:
Household Versus Individual Approaches to Eradication of Community-Associated Staphylococcus aureus in Children: A Randomized Trial
Stephanie A. Fritz1, Patrick G. Hogan1, Genevieve Hayek1, Kimberly A. Eisenstein1, Marcela Rodriguez1, Emma K. Epplin1, Jane Garbutt1,2, and Victoria J. Fraser2
Background. Community-associated Staphylococcus aureus infections often affect multiple members of a household. We compared 2 approaches to S. aureus eradication: decolonizing the entire household versus decolonizing the index case alone.
Methods. An open-label, randomized trial enrolled 183 pediatric patients (cases) with community-onset S. aureus skin abscesses and colonization of anterior nares, axillae, or inguinal folds from 2008 to 2009 at primary and tertiary centers. Participants were randomized to decolonization of the case alone (index group) or of all household members (household group). The 5-day regimen included hygiene education, twice-daily intranasal mupirocin, and daily chlorhexidine body washes. Colonization of cases and subsequent skin and soft tissue infection (SSTI) in cases and household contacts were ascertained at 1, 3, 6, and 12 months.
Results. Among 147 cases with 1-month colonization data, modified intention-to-treat analysis revealed S. aureus eradication in 50% of cases in the index group and 51% in the household group (P = 1.00). Among 126 cases completing 12-month follow-up, S. aureus was eradicated from 54% of the index group versus 66% of the household group (P = .28). Over 12 months, recurrent SSTI was reported in 72% of cases in the index group and 52% in the household group (P = .02). SSTI incidence in household contacts was significantly lower in the household versus index group during the first 6 months; this trend continued at 12 months.
Conclusions. Household decolonization was not more effective than individual decolonization in eradicating community-associated S. aureus carriage from cases. However, household decolonization reduced the incidence of subsequent SSTI in cases and their household contacts.
