脳神経外科領域におけるMRSA感染予防—ムピロシン軟膏の鼻腔内塗布の効果

Prevention of MRSA Spread in the Neurological Field : intranasal application of mupirocin calcium ointment

I．はじめに

　ここ数年来メチシリンに耐性を示す黄色ブドウ球菌methicillin-resistant Staphylococcus aureus（MRSA）によるMRSA感染症の院内流行は大きな問題となっている．市立函館病院では院内感染対策委員会を設置してその予防に務めているが，意識障害を有し臥床状態の患者が多い脳外科病棟ではその対策に苦慮している．近年MRSA感染の重要な要因は鼻腔内に保菌されたMRSAであり^2），ムピロシン軟膏（バクトロバン軟膏^®）を鼻腔内に塗布することでこれを除菌することが可能であると報告されている^8）．

　今回脳神経外科病棟に入院し，MRSAを保菌していない患者の鼻腔内にムピロシン軟膏を塗布し，MRSAの保菌を予防できるかどうか検討したので報告する．

From September 1997 to March 1998, forty patients with cerebral disorders were investigated. Theywere divided into two groups: one treated and the other untreated. Mupirocin calcium ointment (MCO)was applied three times a clay for three days into the nasal cavities of the patients in the treated group. Inorder to check the growth of MRSA (methicillin-resistant Staphylococcus aureus), bacterial isolation cul-ture from the nasal cavity was carried out on admission, one week after admission and one month afteradmission. MRSA was nor detected in isolation culture of any of the cases on admission. One week laterMRSA was detected in isolation culture of one case of the 20 MCO treated patients and in three of the 20 untreated patients. There was no significant difference between treated and untreated groups. In isolationculture after one month, MRSA was recognized in four cases of 16 in the MCO treated group (three pa-tients were discharged and one expired). On the other hand, it was recognized in eight cases of thirteen inthe untreated group (seven cases were discharged). MRSA infection of the nasal cavity decreased signifi-cantly clue to MCO treatment (p＜0.05). It is suggested that the nasal carriage of MRSA was prevented byintranasal application of MCO on admission.