{"id":18203,"date":"2020-01-21T04:59:34","date_gmt":"2020-01-20T20:59:34","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=18203"},"modified":"2020-02-28T06:13:28","modified_gmt":"2020-02-27T22:13:28","slug":"jama%e5%9c%a8%e7%ba%bf%e5%8f%91%e8%a1%a8-%e6%b2%bb%e7%96%97%e9%87%91%e9%bb%84%e8%89%b2%e8%91%a1%e8%90%84%e7%90%83%e8%8f%8c%e5%ae%9a%e6%a4%8d%e7%88%b6%e6%af%8d%e5%af%b9%e4%bc%a0%e6%92%ad%e7%bb%99icu","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=18203","title":{"rendered":"[JAMA\u5728\u7ebf\u53d1\u8868]: \u6cbb\u7597\u91d1\u9ec4\u8272\u8461\u8404\u7403\u83cc\u5b9a\u690d\u7236\u6bcd\u5bf9\u4f20\u64ad\u7ed9ICU\u4e2d\u65b0\u751f\u513f\u7684\u5f71\u54cd"},"content":{"rendered":"\n

Preliminary Communication | December 30, 2019<\/p>\n\n\n\n

Effect of Treating Parents Colonized With Staphylococcus aureus<\/em> on Transmission to Neonates in the Intensive Care Unit: A Randomized Clinical Trial<\/h1>\n\n\n\n

Aaron M. Milstone, Annie Voskertchian, Danielle W. Koontz, et al<\/h3>\n\n\n\n

JAMA. <\/em>Published online December 30, 2019. doi:https:\/\/doi.org\/10.1001\/jama.2019.20785<\/a><\/h3>\n\n\n\n

Abstract<\/h2>\n\n\n\n

Importance<\/strong>\u00a0\u80cc\u666f<\/h3>\n\n\n\n

Staphylococcus aureus<\/em>\u00a0is a leading cause of health care\u2013associated infections in the neonatal intensive care unit (NICU). Parents may expose neonates to\u00a0S aureus<\/em>\u00a0colonization, a well-established predisposing factor to invasive\u00a0S aureus<\/em>\u00a0disease.<\/p>\n\n\n\n

\u91d1\u9ec4\u8272\u8461\u8404\u7403\u83cc\u662f\u65b0\u751f\u513fICU (NICU)\u4e2d\u533b\u9662\u83b7\u5f97\u6027\u611f\u67d3\u6700\u5e38\u89c1\u7684\u75c5\u539f\u5fae\u751f\u7269\u3002\u7236\u6bcd\u53ef\u80fd\u4f7f\u65b0\u751f\u513f\u66b4\u9732\u4e8e\u91d1\u9ec4\u8272\u8461\u8404\u7403\u83cc\u5b9a\u690d\u7684\u98ce\u9669\u4e2d\uff0c\u8fd9\u662f\u4fb5\u88ad\u6027\u91d1\u9ec4\u8272\u8461\u8404\u7403\u83cc\u611f\u67d3\u7684\u6613\u611f\u56e0\u7d20\u3002<\/p>\n\n\n\n

Objective<\/strong>\u00a0\u76ee\u7684<\/h3>\n\n\n\n

To test whether treating parents with intranasal mupirocin and topical chlorhexidine compared with placebo would reduce transmission of\u00a0S aureus<\/em>\u00a0from parents to neonates.<\/p>\n\n\n\n

\u9a8c\u8bc1\u4e0e\u5b89\u6170\u5242\u76f8\u6bd4\uff0c\u9f3b\u524d\u5ead\u83ab\u5339\u7f57\u661f\u53ca\u5c40\u90e8\u6d17\u5fc5\u6cf0\u6cbb\u7597\u7236\u6bcd\uff0c\u80fd\u5426\u51cf\u5c11\u4ece\u91d1\u9ec4\u8272\u8461\u8404\u7403\u83cc\u4ece\u7236\u6bcd\u5411\u65b0\u751f\u513f\u7684\u4f20\u64ad\u3002<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong> \u8bd5\u9a8c\u8bbe\u8ba1\u3001\u573a\u666f\u53ca\u7814\u7a76\u5bf9\u8c61\u00a0<\/h3>\n\n\n\n

Double-blinded randomized clinical trial in 2 tertiary NICUs in Baltimore, Maryland. Neonates (n\u2009=\u2009236) with\u00a0S aureus<\/em>\u2013colonized parent(s) were enrolled. The study period was November 7, 2014, through December 13, 2018.<\/p>\n\n\n\n

\u9a6c\u91cc\u5170\u5dde\u5df4\u5c14\u7684\u6469\u5e02\u76842\u4e2a\u4e09\u7ea7ICU\u8fdb\u884c\u7684\u53cc\u76f2\u968f\u673a\u4e34\u5e8a\u8bd5\u9a8c\uff0c\u5165\u9009\u7236\u6bcd\u6709\u91d1\u9ec4\u8272\u8461\u8404\u7403\u83cc\u5b9a\u690d\u7684\u65b0\u751f\u513f(n = 236)\u3002\u7814\u7a76\u4ece2014\u5e7411\u67087\u65e5\u81f32018\u5e7412\u670813\u65e5\u8fdb\u884c\u3002<\/p>\n\n\n\n

Interventions<\/strong> \u5e72\u9884\u63aa\u65bd\u00a0<\/h3>\n\n\n\n

Parents were assigned to intranasal mupirocin and 2% chlorhexidine\u2013impregnated cloths (active treatment, n\u2009=\u2009117) or petrolatum intranasal ointment and nonmedicated soap cloths (placebo, n\u2009=\u2009119) for 5 days.<\/p>\n\n\n\n

\u5c06\u7236\u6bcd\u968f\u673a\u5206\u7ec4\uff0c\u5206\u522b\u4f7f\u7528\u9f3b\u524d\u5ead\u83ab\u5339\u7f57\u661f\u53ca2%\u6d17\u5fc5\u6cf0\u6d78\u6da6\u5e03(\u6d3b\u6027\u6cbb\u7597\u7ec4, n\u2009=\u2009117) \u6216\u51e1\u58eb\u6797\u9f3b\u818f\u53ca\u65e0\u836f\u7269\u80a5\u7682\u5e03 (\u5b89\u6170\u5242, n\u2009=\u2009119)\u3002<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong>\u00a0\u4e3b\u8981\u9884\u540e\u6307\u6807<\/h3>\n\n\n\n

The primary end point was concordant\u00a0S aureus<\/em> colonization by 90 days, defined as neonatal acquisition of an\u00a0S aureus<\/em>\u00a0strain that was the same strain as a parental strain at time of screening. Secondary outcomes included neonatal acquisition of any\u00a0S aureus<\/em>\u00a0strain and neonatal\u00a0S aureus<\/em> infections.<\/p>\n\n\n\n

\u4e3b\u8981\u9884\u540e\u7ec8\u70b9\u4e3a90\u5929\u5185\u91d1\u9ec4\u8272\u8461\u8404\u7403\u83cc\u7684\u4e00\u81f4\u6027\u5b9a\u690d\uff0c\u5b9a\u4e49\u4e3a\u65b0\u751f\u513f\u83b7\u5f97\u7684\u91d1\u9ec4\u8272\u8461\u8404\u7403\u83cc\u83cc\u682a\u4e0e\u7b5b\u67e5\u65f6\u7236\u6bcd\u7684\u83cc\u682a\u76f8\u540c\u3002\u6b21\u8981\u9884\u540e\u7ec8\u70b9\u5305\u62ec\u65b0\u751f\u513f\u83b7\u5f97\u4efb\u4f55\u91d1\u9ec4\u8272\u8461\u8404\u7403\u83cc\u83cc\u682a\u53ca\u65b0\u751f\u513f\u91d1\u9ec4\u8272\u8461\u8404\u7403\u83cc\u611f\u67d3\u3002<\/p>\n\n\n\n

Results<\/strong> \u7ed3\u679c<\/h3>\n\n\n\n

Among 236 randomized neonates, 208 were included in the analytic sample (55% male; 76% singleton births; mean birth weight, 1985 g [SD, 958 g]; 76% vaginal birth; mean parent age, 31 [SD, 7] years), of whom 18 were lost to follow-up. Among 190 neonates included in the analysis, 74 (38.9%) acquired\u00a0S aureus<\/em>colonization by 90 days, of which 42 (56.8%) had a strain concordant with a parental baseline strain. In the intervention and placebo groups, 13 of 89 neonates (14.6%) and 29 of 101 neonates (28.7%), respectively, acquired concordant\u00a0S aureus<\/em>\u00a0colonization (risk difference, \u201314.1% [95% CI, \u201330.8% to \u20133.9%]; hazard ratio [HR], 0.43 [95.2% CI, 0.16 to 0.79]). A total of 28 of 89 neonates (31.4%) in the intervention group and 46 of 101 (45.5%) in the control group acquired any\u00a0S aureus<\/em>\u00a0strain (HR, 0.57 [95% CI, 0.31 to 0.88]), and 1 neonate (1.1%) in the intervention group and 1 neonate (1.0%) in the control group developed an\u00a0S aureus<\/em>\u00a0infection before colonization. Skin reactions in parents were common (4.8% intervention, 6.2% placebo).<\/p>\n\n\n\n

\u5728 236 \u540d\u63a5\u53d7\u968f\u673a\u5206\u7ec4\u7684\u65b0\u751f\u513f\u4e2d\uff0c208\u540d\u7eb3\u5165\u5206\u6790\u6837\u672c (55% \u7537\u6027; 76% \u5355\u4ea7\u513f; \u5e73\u5747\u51fa\u751f\u4f53\u91cd, 1985 g [SD, 958 g]; 76% \u9634\u9053\u751f\u4ea7; \u7236\u6bcd\u5e73\u5747\u5e74\u9f84, 31 [SD, 7] \u5c81), \u5176\u4e2d18 \u540d\u5931\u8bbf\u3002\u5728\u7eb3\u5165\u5206\u6790\u7684190 \u540d\u65b0\u751f\u513f\u4e2d\uff0c90\u5929\u518574 \u540d (38.9%) \u53d1\u751f\u91d1\u9ec4\u8272\u8461\u8404\u7403\u83cc\u5b9a\u690d\uff0c\u5176\u4e2d 42 \u540d (56.8%) \u4e0e\u7236\u6bcd\u57fa\u7ebf\u83cc\u682a\u76f8\u4e00\u81f4\u3002\u5728\u5e72\u9884\u7ec4\u53ca\u5b89\u6170\u5242\u7ec4\uff0c\u5206\u522b\u6709 89 \u540d\u65b0\u751f\u513f\u4e2d\u768413 \u540d (14.6%) \u53ca 101 \u540d\u65b0\u751f\u513f\u4e2d\u768429 \u540d (28.7%) \u53d1\u751f\u91d1\u9ec4\u8272\u8461\u8404\u7403\u83cc\u4e00\u81f4\u6027\u5b9a\u690d (\u98ce\u9669\u5dee\u5f02, \u201314.1% [95% CI, \u201330.8% to \u20133.9%]; \u98ce\u9669\u6bd4 [HR], 0.43 [95.2% CI, 0.16 to 0.79])\u3002\u5e72\u9884\u7ec4 89 \u540d\u65b0\u751f\u513f\u4e2d 28 \u540d (31.4%) \u53ca\u5bf9\u7167\u7ec4 101 \u540d\u65b0\u751f\u513f\u4e2d 46 \u540d (45.5%) \u83b7\u5f97\u4efb\u4f55\u91d1\u9ec4\u8272\u8461\u8404\u7403\u83cc (HR, 0.57 [95% CI, 0.31 to 0.88])\uff0c\u5e72\u9884\u7ec4\u548c\u6cbb\u7597\u7ec4\u5206\u522b\u67091\u540d\u65b0\u751f\u513f (1.1% vs. 1.0%) \u5728\u5b9a\u690d\u94b1\u53d1\u751f\u91d1\u9ec4\u8272\u8461\u8404\u7403\u83cc\u611f\u67d3\u3002\u7236\u6bcd\u76ae\u80a4\u53cd\u5e94\u5e38\u89c1 (\u5e72\u9884\u7ec44.8%, \u5b89\u6170\u5242\u7ec4 6.2%)\u3002<\/p>\n\n\n\n

\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n

Conclusions and Relevance<\/strong>\u00a0\u7ed3\u8bba\u4e0e\u610f\u4e49<\/h3>\n\n\n\n

In this preliminary trial of parents colonized with\u00a0S aureus<\/em>, treatment with intranasal mupirocin and chlorhexidine-impregnated cloths compared with placebo significantly reduced neonatal colonization with an\u00a0S aureus<\/em>\u00a0strain concordant with a parental baseline strain. However, further research is needed to replicate these findings and to assess their generalizability.<\/p>\n\n\n\n

\u5728\u8fd9\u9879\u9488\u5bf9\u91d1\u9ec4\u8272\u8461\u8404\u7403\u83cc\u5b9a\u690d\u7684\u7236\u6bcd\u521d\u6b65\u8bd5\u9a8c\u4e2d\uff0c\u4e0e\u5b89\u6170\u5242\u76f8\u6bd4\uff0c\u4f7f\u7528\u9f3b\u524d\u5ead\u83ab\u5339\u7f57\u661f\u53ca\u6d17\u5fc5\u6cf0\u6d78\u6da6\u5e03\u80fd\u591f\u663e\u8457\u51cf\u5c11\u4e0e\u7236\u6bcd\u57fa\u7ebf\u83cc\u682a\u4e00\u81f4\u7684\u91d1\u9ec4\u8272\u8461\u8404\u7403\u83cc\u83cc\u682a\u5728\u65b0\u751f\u513f\u7684\u5b9a\u690d\u3002\u7136\u800c\uff0c\u9700\u8981\u8fdb\u4e00\u6b65\u7814\u7a76\u9a8c\u8bc1\u8fd9\u4e00\u7ed3\u679c\u5e76\u8bc4\u4f30\u5176\u53ef\u63a8\u5e7f\u6027\u3002<\/p>\n\n\n\n

Trial Registration<\/strong>\u00a0\u8bd5\u9a8c\u6ce8\u518c<\/h3>\n\n\n\n

ClinicalTrials.gov Identifier: NCT02223520<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Preliminary Communication | December 30,&nbsp […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18203"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=18203"}],"version-history":[{"count":3,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18203\/revisions"}],"predecessor-version":[{"id":18209,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18203\/revisions\/18209"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=18203"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=18203"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=18203"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}