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NEJM:克林霉素与甲氧苄氨嘧啶-磺胺甲基异恶唑对非复杂性皮肤感染的治疗

2015-03-26 崔倩译 MedSci原创

背景 皮肤和皮肤结构感染在医疗门诊中是常见的。然而,各种抗生素疗法在社区获得性耐甲氧西林金黄色葡萄球菌(MRSA)的的疗效还不清楚。 方法 我们招募了单纯性蜂窝组织炎皮肤感染,脓肿大于5厘米,直径(年幼的孩子),或两者兼而有之的患者。患者参加了四个研究试点。所有都接受了脓肿切开引流术。患者按1:1的比例被随机分配接受克林霉素组或甲氧苄啶 - 磺胺甲恶唑(TMP-SMX)组,周期为10天。患者和研

背景 皮肤和皮肤结构感染在医疗门诊中是常见的。然而,各种抗生素疗法在社区获得性耐甲氧西林金黄色葡萄球菌(MRSA)的的疗效还不清楚。

方法 我们招募了单纯性蜂窝组织炎皮肤感染,脓肿大于5厘米,直径(年幼的孩子),或两者兼而有之的患者。患者参加了四个研究试点。所有都接受了脓肿切开引流术。患者按1:1的比例被随机分配接受克林霉素组或甲氧苄啶 - 磺胺甲恶唑(TMP-SMX)组,周期为10天。患者和研究者都不知道治疗分配和微生物学测试结果。主要成果是在临床治愈治疗结束后7〜10天得到。

结果 总共524名患者参加(264例在克林霉素组和260例在TMP-SMX组),包括155名儿童(29.6%)。160例(30.5%),有一个脓肿,280例(53.4%)有蜂窝组织炎,和82例(15.6%)有混合感染,被定义为至少有一个脓肿病灶和一个蜂窝组织炎病灶。金黄色葡萄球菌是从217例(41.4%)分离出来的;分离出的这些患者中167例(77.0%)为MRSA患者。患者治愈的比例是在两个治疗组的意向性治疗人群(克林霉素组为80.3%和TMP-SMX组为77.7%;差异为-2.6个百分点; 95%的置信区间[CI ],-10.2〜4.9; P = 0.52),并且可以被评估的患者人群(466例,氯林可霉素组为89.5%和TMP-SMX组为88.2%; 差异为-1.2个百分点; 95% CI,-7.6〜5.1; P = 0.77)。治愈率在两种治疗患有脓肿与蜂窝织炎的儿童,成人患者亚组之间显著不同。两个组中患者的不良事件的比例是相似的。

结论 我们发现,对于治疗复杂的皮肤感染,包括蜂窝织炎和脓肿的任何疗效或副作用,克林霉素和TMP-SMX之间无显著差异。

原始出处

Loren G. Miller, M.D., M.P.H., Robert S. Daum, M.D., C.M., C. Buddy Creech, M.D., M.P.H., David Young, M.D., Michele D. Downing, R.N., M.S.N., Samantha J. Eells, M.P.H., Stephanie Pettibone, B.S., Rebecca J. Hoagland, M.S., and Henry F. Chambers, M.D. for the DMID 07-0051 Team.Clindamycin versus Trimethoprim–Sulfamethoxazole for Uncomplicated Skin Infections.NEJM.2014

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