RESUMO
OBJECTIVES: The objective of this study was to evaluate the efficacy of polyhexanide (Prontoderm(®)) in eliminating MRSA carriage. METHODS: In a 1900 bed teaching hospital, MRSA-colonized patients were randomized into a double-blind, placebo-controlled superiority trial between January 2011 and July 2014. Patients were treated with either polyhexanide or placebo applied to the anterior nares (thrice daily) and skin (once daily) for 10 days. The primary outcome was MRSA decolonization at day 28 (D28) after the end of treatment assessed by ITT responder and PP analyses (microbiological follow-up ± 7 days and topical treatment ≥ 5 days). Secondary outcomes included safety, emergence of resistance and MRSA genotype changes. Registered trial number ISRCTN02288276. RESULTS: Of 2590 patients screened, 146 (polyhexanide group, 71; placebo group, 75) were included. ITT analysis showed that 24/71 (33.8%) patients in the polyhexanide group versus 22/75 (29.3%) in the placebo group were MRSA-free at D28 (risk difference, 4.5%; 95% CI, -10.6% to 19.5%; P = 0.56). PP analysis confirmed the results with 19/53 (35.8%) decolonized polyhexanide-treated patients versus 17/56 (30.4%) in the placebo arm (risk difference, 5.5%; 95% CI, -12.2% to 23%; P = 0.54). Nine serious adverse events occurred in the polyhexanide group versus 12 in the placebo group; none was attributable to study medication. Emergence of polyhexanide resistance or cross-resistance between polyhexanide and chlorhexidine was not observed. No case of exogenous recolonization by a genotypically different MRSA strain was documented. CONCLUSIONS: This study suggests that under real-life conditions, a single polyhexanide decolonization course is not effective in eradicating MRSA carriage.
Assuntos
Anti-Infecciosos Locais/administração & dosagem , Biguanidas/administração & dosagem , Portador Sadio/tratamento farmacológico , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções Estafilocócicas/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Infecciosos Locais/efeitos adversos , Biguanidas/efeitos adversos , Portador Sadio/microbiologia , Método Duplo-Cego , Farmacorresistência Bacteriana , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Feminino , Hospitais de Ensino , Humanos , Masculino , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Pessoa de Meia-Idade , Placebos/administração & dosagem , Infecções Estafilocócicas/microbiologia , Resultado do Tratamento , Adulto JovemRESUMO
Acanthocephala are endoparasitic worms with a characteristic retractile proboscis bearing rows of thorny hooks. They have been found in all classes of vertebrates; however, human infection appears to be rare and accidental. To date, all reported cases of acanthocephalans in humans have involved the gastrointestinal tract. Here we report for the first time the highly unusual finding of an immature acanthocephalan retrieved from a patient's eye.