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Titolo:
RANDOMIZED DOUBLE-BLINDED TRIAL OF RIFAMPIN WITH EITHER NOVOBIOCIN ORTRIMETHOPRIM-SULFAMETHOXAZOLE AGAINST METHICILLIN-RESISTANT STAPHYLOCOCCUS-AUREUS COLONIZATION - PREVENTION OF ANTIMICROBIAL RESISTANCE ANDEFFECT OF HOST FACTORS ON OUTCOME
Autore:
WALSH TJ; STANDIFORD HC; REBOLI AC; JOHN JF; MULLIGAN ME; RIBNER BS; MONTGOMERIE JZ; GOETZ MB; MAYHALL CG; RIMLAND D; STEVENS DA; HANSEN SL; GERARD GC; RAGUAL RJ;
Indirizzi:
BALTIMORE VET AFFAIRS MED CTR,INFECT DIS SECT BALTIMORE MD 21201 BALTIMORE VET AFFAIRS MED CTR,INFECT DIS SECT BALTIMORE MD 21201 UNIV MARYLAND,SCH MED BALTIMORE MD 21201 MED UNIV S CAROLINA CHARLESTON SC 29425 NCI BETHESDA MD 20892 VET AFFAIRS MED CTR CHARLESTON SC 29425 W LOS ANGELES VET AFFAIRS MED CTR LOS ANGELES CA 90024 UNIV CALIF LOS ANGELES,SCH MED LOS ANGELES CA 90024 ASHEVILLE VET AFFAIRS MED CTR ASHEVILLE NC 28805 DUKE UNIV,MED CTR DURHAM NC 27710 RANCHO LOS AMIGOS MED CTR DOWNEY CA 90242 UNIV CALIF LOS ANGELES,SEPULVEDA VET AFFAIRS MED CTR LOS ANGELES CA 90024 VIRGINIA COMMONWEALTH UNIV MED COLL VIRGINIA RICHMOND VA 23219 VET AFFAIRS MED CTR DECATUR GA 30033 EMORY UNIV,SCH MED ATLANTA GA 30322 SANTA CLARA VALLEY MED CTR SAN JOSE CA 95128 STANFORD UNIV,SCH MED,CALIF INST MED RES SAN JOSE CA 94305 UPJOHN CO KALAMAZOO MI 49001
Titolo Testata:
Antimicrobial agents and chemotherapy
fascicolo: 6, volume: 37, anno: 1993,
pagine: 1334 - 1342
SICI:
0066-4804(1993)37:6<1334:RDTORW>2.0.ZU;2-D
Fonte:
ISI
Lingua:
ENG
Soggetto:
NASAL CARRIAGE; HOSPITAL OUTBREAK; UNITED-STATES; INFECTIONS; MUPIROCIN; ERADICATION; EFFICACY; THERAPY; HEMODIALYSIS; PROPHYLAXIS;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Science Citation Index Expanded
Citazioni:
56
Recensione:
Indirizzi per estratti:
Citazione:
T.J. Walsh et al., "RANDOMIZED DOUBLE-BLINDED TRIAL OF RIFAMPIN WITH EITHER NOVOBIOCIN ORTRIMETHOPRIM-SULFAMETHOXAZOLE AGAINST METHICILLIN-RESISTANT STAPHYLOCOCCUS-AUREUS COLONIZATION - PREVENTION OF ANTIMICROBIAL RESISTANCE ANDEFFECT OF HOST FACTORS ON OUTCOME", Antimicrobial agents and chemotherapy, 37(6), 1993, pp. 1334-1342

Abstract

Methicillin-resistant Staphylococcus aureus (MRSA) is a major pathogen in hospitals. Current antimicrobial regimens for eradicating colonizing strains are not well defined and are often complicated by the emergence of resistance. The combination of novobiocin plus rifampin in vitro and in vivo was found to prevent the emergence of resistant populations of initially susceptible strains of MRSA, particularly resistance to rifampin. We therefore studied, in a randomized, double-blind, multicenter comparative trial, the combination of novobiocin plus rifampin versus trimethoprim-sulfamethoxazole (T/S) plus rifampin in order to determine the efficacy of each regimen in eradicating MRSA colonization and to further characterize the host factors involved in the response to this antimicrobial therapy. Among the 126 individuals enrolled in the study, 94 (80 patients; 14 hospital personnel) were evaluable. Among the 94 evaluable subjects, no significant demographic or medicaldifferences existed between the two treatment groups. Successful clearance of the colonizing MRSA strains was achieved in 30 of 45 (67%) subjects receiving novobiocin plus rifampin, whereas successful clearance was achieved in 26 of 49 (53%) subjects treated with T/S plus rifampin (P = 0.18). The emergence of resistance to rifampin developed more frequently in 14% (7 of 49) of subjects treated with T/S plus rifampinthan in 2% (1 of 45) of subjects treated with novobiocin plus rifampin (P = 0.04). Restriction endonuclease studies of large plasmid DNA demonstrated that the same strain was present at pretherapy and posttherapy in most refractory cases (24 of 29 [83%] subjects). Among the 56 successfully treated subjects, clearance of MRSA was age dependent: 29 of 36 (80%) subjects in the 18- to 49-year-old age group, 19 of 35 (54%) subjects in the 50- to 69-year-old age group, and 8 of 23 (35%) in the 70- to 94-year-old age group (P < 0.01). Clearance was also site dependent; culture-positive samples from wounds were related to a successful outcome in only 22 (48%) of 46 subjects, whereas culture-positive samples from sites other than wounds (e.g., nares, rectum, and sputum) were associated with a success rate of 34 of 48 (71%) subjects (P =0.02). Foreign bodies in wounds did not prevent the eradication of MRSA by either regimen. T/S plus rifampin was less effective in clearingpressure wounds compared with other wounds, whereas novobiocin plus rifampin was equally effective in clearing both pressure and other wounds. There were no significant differences in toxicity between the two regimens. Thus, the combination of novobiocin plus rifampin, in comparison with T/S plus rifampin, was more effective in preventing the emergence of resistance to rifampin and demonstrated a trend toward greater activity in clearing the MRSA carrier state. The response to either combination depended on host factors, particularly age and the site ofMRSA colonization.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 21/09/20 alle ore 06:11:36