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Jinushi K, Shimizu J, Yamashita M, Odagiri K, Yanagimoto Y, Takeyama H, Suzuki Y, Ikenaga M, Imamura H, Dono K. Association between methicillin-resistant Staphylococcus aureus nasal carriage and infection after pancreatic surgery. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2024; 31:42-49. [PMID: 37792598 DOI: 10.1002/jhbp.1371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/07/2023] [Accepted: 08/16/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) infections after pancreatectomy are relatively rare; however, they can be fatal when associated with pseudoaneurysms. For the past 12 years, we have been investigating nasal MRSA carriage by polymerase chain reaction testing, postoperatively in patients admitted to the intensive care units, to prevent nosocomial infections. Here, we investigated the relationship between MRSA nasal carriage and postoperative MRSA infection at the surgical site, following pancreatectomy. METHODS This single-center retrospective study analyzed 313 pancreatectomies (220 pancreaticoduodenectomies and 93 distal pancreatectomies), performed at our hospital between January 2011 and June 2022. The incidence of surgical site infection (SSI) and postoperative MRSA infection were compared between the nasal MRSA-positive and nasal MRSA-negative groups. RESULTS MRSA nasal carriage was identified in 24 cases (7.6%), and the frequency of SSIs in the nasal MRSA-positive and MRSA-negative groups were 50% and 36.7%, respectively, with no significant difference (p = .273). However, the frequency of MRSA infection among the SSI cases was significantly higher in the nasal MRSA-positive group (16.7%) than in the nasal MRSA-negative group (1.7%) (p = .003). CONCLUSION It should be noted that MRSA carriers have a significantly higher frequency of MRSA-positive SSIs.
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Affiliation(s)
- Koichi Jinushi
- Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan
| | - Junzo Shimizu
- Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan
| | | | - Kazuki Odagiri
- Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan
| | | | - Hiroshi Takeyama
- Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan
| | - Yozo Suzuki
- Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan
| | - Masakazu Ikenaga
- Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan
| | - Hiroshi Imamura
- Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan
| | - Keizo Dono
- Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan
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2
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Rapidly progressive infective endocarditis after MitraClip therapy: A rare complication of transcatheter edge-to-edge mitral valve repair. J Cardiol Cases 2023. [DOI: 10.1016/j.jccase.2023.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
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3
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Toyama Y, Hisata K, Kasai Y, Nakano S, Komatsu M, Shimizu T. Molecular epidemiology of methicillin-sensitive Staphylococcus aureus in the neonatal intensive care unit. J Hosp Infect 2022; 129:75-81. [PMID: 35987317 DOI: 10.1016/j.jhin.2022.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/30/2022] [Accepted: 07/25/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Staphylococcus aureus-both meticillin-resistant S. aureus (MRSA) and meticillin-sensitive S. aureus (MSSA)-is a major cause of neonatal infections. Infection control measures have not lowered the incidence of MSSA infections to the same degree as that of MRSA infections. AIM To investigate the transmission pathway of MSSA in neonatal intensive care unit (NICU) using genetic analysis. METHODS We swab-tested neonatal patients, their parents, and healthcare workers (HCW) in the NICU at our hospital at the time of hospitalisation and then every month thereafter from 1st October 2018 to 31st March 2019. We performed whole-genome sequencing (WGS) to test for MSSA strains. Multilocus sequence typing (MLST) and single nucleotide polymorphism (SNP) analysis were used to identify strains and understand their relatedness. FINDINGS There were 16 MSSA-positive patients. Four MSSA-positive patients shared strains from the same phylogenetic groups as those of HCW. One presented the same strain as the parent. MSSA-positive twin neonates shared the same strain. Ten had sporadic strains; 32 of the ninety-seven tested healthcare workers were MSSA positive. CONCLUSION The findings of this study suggest that the route of transmission of MSSA in NICU may be through MSSA in the hospital environment in addition to horizontal transmission via healthcare workers. Along with hand hygiene with alcohol, thorough environmental maintenance and parental education are important for infection control in NICUs targeting MSSA.
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Affiliation(s)
- Yudai Toyama
- Department of Pediatrics and Adolescent Medicine, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Ken Hisata
- Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, Juntendo University, Tokyo, Japan.
| | - Yuriha Kasai
- Department of Pediatrics and Adolescent Medicine, Graduate School of Medicine, Juntendo University, Tokyo, Japan; Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Saki Nakano
- Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, Juntendo University, Tokyo, Japan; Department of Pediatrics, Tokyo Rinkai Hospital, Tokyo, Japan
| | - Mitsutaka Komatsu
- Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Toshiaki Shimizu
- Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, Juntendo University, Tokyo, Japan
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Coia JE, Wilson JA, Bak A, Marsden GL, Shimonovich M, Loveday HP, Humphreys H, Wigglesworth N, Demirjian A, Brooks J, Butcher L, Price JR, Ritchie L, Newsholme W, Enoch DA, Bostock J, Cann M, Wilson APR. Joint Healthcare Infection Society (HIS) and Infection Prevention Society (IPS) guidelines for the prevention and control of meticillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities. J Hosp Infect 2021; 118S:S1-S39. [PMID: 34757174 DOI: 10.1016/j.jhin.2021.09.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/03/2021] [Accepted: 09/13/2021] [Indexed: 12/28/2022]
Affiliation(s)
- J E Coia
- Department of Clinical Microbiology, Hospital South West Jutland, Esbjerg, Denmark; Department of Regional Health Research IRS, University of Southern Denmark, Denmark; Healthcare Infection Society, London, UK
| | - J A Wilson
- Richard Wells Research Centre, University of West London, London, UK; Infection Prevention Society, Seafield, UK
| | - A Bak
- Healthcare Infection Society, London, UK.
| | | | - M Shimonovich
- Healthcare Infection Society, London, UK; MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - H P Loveday
- Richard Wells Research Centre, University of West London, London, UK; Infection Prevention Society, Seafield, UK
| | - H Humphreys
- Healthcare Infection Society, London, UK; Department of Clinical Microbiology, The Royal College of Surgeons, Ireland; Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - N Wigglesworth
- Infection Prevention Society, Seafield, UK; East Kent Hospitals University, NHS Foundation Trust, Canterbury, UK
| | - A Demirjian
- Healthcare-associated Infection and Antimicrobial Resistance, Public Health England, London, UK; Paediatric Infectious Diseases and Immunology, Evelina London Children's Hospital, London, UK; Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - J Brooks
- Infection Prevention Society, Seafield, UK; University Hospital Southampton NHS Foundation Trust, UK
| | - L Butcher
- Infection Prevention Society, Seafield, UK; Oxford University Hospitals NHS Foundation Trust, UK
| | - J R Price
- Healthcare Infection Society, London, UK; Imperial College Healthcare NHS Trust, London, UK
| | - L Ritchie
- Healthcare Infection Society, London, UK; NHS England and NHS Improvement, London, UK
| | - W Newsholme
- Healthcare Infection Society, London, UK; Guy's and St Thomas' NHS Foundation Trust, UK
| | - D A Enoch
- Healthcare Infection Society, London, UK; Clinical Microbiology & Public Health Laboratory, Public Health England, Addenbrooke's Hospital, Cambridge, UK
| | | | - M Cann
- Lay Member, UK; MRSA Action UK, Preston, UK
| | - A P R Wilson
- Healthcare Infection Society, London, UK; University College London Hospitals NHS Foundation Trust, UK.
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5
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Lee AS, Huttner BD, Catho G, Harbarth S. Methicillin-Resistant Staphylococcus aureus: An Update on Prevention and Control in Acute Care Settings. Infect Dis Clin North Am 2021; 35:931-952. [PMID: 34752226 DOI: 10.1016/j.idc.2021.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a leading cause of health-care-associated infections. Controversies regarding the effectiveness of various control strategies have contributed to varying approaches to MRSA control. However, new evidence from large-scale studies has emerged, particularly concerning screening and decolonization. Importantly, implementation and outcomes of control measures in practice are not only influenced by scientific evidence, but also economic, administrative, and political factors, as demonstrated by decreasing MRSA rates in a number of countries after concerted and coordinated efforts at a national level. Flexibility to adapt measures based on local epidemiology and resources is essential for successful MRSA control.
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Affiliation(s)
- Andie S Lee
- Departments of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, University of Sydney, Missenden Road, Camperdown, Sydney, NSW 2050, Australia.
| | - Benedikt D Huttner
- Division of Infectious Diseases, University of Geneva Hospitals, University of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva CH-1205, Switzerland
| | - Gaud Catho
- Infection Control Programme, University of Geneva Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva CH-1205, Switzerland
| | - Stephan Harbarth
- Infection Control Programme, University of Geneva Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva CH-1205, Switzerland
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6
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Tobin JN, Hower S, D’Orazio BM, Pardos de la Gándara M, Evering TH, Khalida C, Ramachandran J, González LJ, Kost RG, Vasquez KS, de Lencastre H, Tomasz A, Coller BS, Vaughan R. Comparative Effectiveness Study of Home-Based Interventions to Prevent CA-MRSA Infection Recurrence. Antibiotics (Basel) 2021; 10:antibiotics10091105. [PMID: 34572687 PMCID: PMC8465828 DOI: 10.3390/antibiotics10091105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 08/30/2021] [Accepted: 09/02/2021] [Indexed: 11/16/2022] Open
Abstract
Recurrent skin and soft tissue infections (SSTI) caused by Community-Associated Methicillin-Resistant Staphylococcus aureus (CA-MRSA) or Methicillin-Sensitive Staphylococcus aureus (CA-MSSA) present treatment challenges. This community-based trial examined the effectiveness of an evidence-based intervention (CDC Guidelines, topical decolonization, surface decontamination) to reduce SSTI recurrence, mitigate household contamination/transmission, and improve patient-reported outcomes. Participants (n = 186) were individuals with confirmed MRSA(+)/MSSA(+) SSTIs and their household members. During home visits; Community Health Workers/Promotoras provided hygiene instructions; a five-day supply of nasal mupirocin; chlorhexidine for body cleansing; and household disinfecting wipes (Experimental; EXP) or Usual Care Control (UC CON) pamphlets. Primary outcome was six-month SSTI recurrence from electronic health records (EHR). Home visits (months 0; 3) and telephone assessments (months 0; 1; 6) collected self-report data. Index patients and participating household members provided surveillance culture swabs. Secondary outcomes included household surface contamination; household member colonization and transmission; quality of life; and satisfaction with care. There were no significant differences in SSTI recurrence between EXP and UC in the intent-to-treat cohort (n = 186) or the enrolled cohort (n = 119). EXP participants showed reduced but non-significant colonization rates. EXP and UC did not differ in household member transmission, contaminated surfaces, or patient-reported outcomes. This intervention did not reduce clinician-reported MRSA/MSSA SSTI recurrence. Taken together with other recent studies that employed more intensive decolonization protocols, it is possible that a promotora-delivered intervention instructing treatment for a longer or repetitive duration may be effective and should be examined by future studies.
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Affiliation(s)
- Jonathan N. Tobin
- Clinical Directors Network, Inc. (CDN), New York, NY 10018, USA; (S.H.); (B.M.D.); (C.K.); (J.R.); (L.J.G.)
- Center for Clinical and Translational Science, The Rockefeller University, New York, NY 10065, USA; (M.P.d.l.G.); (T.H.E.); (R.G.K.); (K.S.V.); (B.S.C.); (R.V.)
- Correspondence: ; Tel.: +1-(212)-382-0699
| | - Suzanne Hower
- Clinical Directors Network, Inc. (CDN), New York, NY 10018, USA; (S.H.); (B.M.D.); (C.K.); (J.R.); (L.J.G.)
| | - Brianna M. D’Orazio
- Clinical Directors Network, Inc. (CDN), New York, NY 10018, USA; (S.H.); (B.M.D.); (C.K.); (J.R.); (L.J.G.)
| | - María Pardos de la Gándara
- Center for Clinical and Translational Science, The Rockefeller University, New York, NY 10065, USA; (M.P.d.l.G.); (T.H.E.); (R.G.K.); (K.S.V.); (B.S.C.); (R.V.)
- Institut Pasteur, 75015 Paris, France
| | - Teresa H. Evering
- Center for Clinical and Translational Science, The Rockefeller University, New York, NY 10065, USA; (M.P.d.l.G.); (T.H.E.); (R.G.K.); (K.S.V.); (B.S.C.); (R.V.)
- Weill Cornell Medicine, New York, NY 10065, USA
| | - Chamanara Khalida
- Clinical Directors Network, Inc. (CDN), New York, NY 10018, USA; (S.H.); (B.M.D.); (C.K.); (J.R.); (L.J.G.)
| | - Jessica Ramachandran
- Clinical Directors Network, Inc. (CDN), New York, NY 10018, USA; (S.H.); (B.M.D.); (C.K.); (J.R.); (L.J.G.)
- Metropolitan Hospital Center, New York City Health + Hospitals, New York, NY 10029, USA
| | - Leidy Johana González
- Clinical Directors Network, Inc. (CDN), New York, NY 10018, USA; (S.H.); (B.M.D.); (C.K.); (J.R.); (L.J.G.)
- Metropolitan Hospital Center, New York City Health + Hospitals, New York, NY 10029, USA
| | - Rhonda G. Kost
- Center for Clinical and Translational Science, The Rockefeller University, New York, NY 10065, USA; (M.P.d.l.G.); (T.H.E.); (R.G.K.); (K.S.V.); (B.S.C.); (R.V.)
| | - Kimberly S. Vasquez
- Center for Clinical and Translational Science, The Rockefeller University, New York, NY 10065, USA; (M.P.d.l.G.); (T.H.E.); (R.G.K.); (K.S.V.); (B.S.C.); (R.V.)
| | - Hermínia de Lencastre
- Laboratory of Microbiology and Infectious Diseases, The Rockefeller University, New York, NY 10065, USA; (H.d.L.); (A.T.)
- Instituto de Tecnologia Química e Biológica (ITQB/UNL), 2780-157 Oeiras, Portugal
| | - Alexander Tomasz
- Laboratory of Microbiology and Infectious Diseases, The Rockefeller University, New York, NY 10065, USA; (H.d.L.); (A.T.)
| | - Barry S. Coller
- Center for Clinical and Translational Science, The Rockefeller University, New York, NY 10065, USA; (M.P.d.l.G.); (T.H.E.); (R.G.K.); (K.S.V.); (B.S.C.); (R.V.)
| | - Roger Vaughan
- Center for Clinical and Translational Science, The Rockefeller University, New York, NY 10065, USA; (M.P.d.l.G.); (T.H.E.); (R.G.K.); (K.S.V.); (B.S.C.); (R.V.)
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7
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Babiker A, Lutgring JD, Fridkin S, Hayden MK. Assessing the Potential for Unintended Microbial Consequences of Routine Chlorhexidine Bathing for Prevention of Healthcare-associated Infections. Clin Infect Dis 2021; 72:891-898. [PMID: 32766819 DOI: 10.1093/cid/ciaa1103] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 07/28/2020] [Indexed: 11/13/2022] Open
Abstract
Chlorhexidine gluconate (CHG) is an antiseptic that is widely used in healthcare due to its excellent safety profile and wide spectrum of activity. Daily bathing with CHG has proven to be effective in the prevention of healthcare-associated infections and multidrug-resistant pathogen decolonization. Despite the proven benefits of CHG use, there remain concerns and unanswered questions about the potential for unintended microbial consequences of routine CHG bathing. This review aims to explore some of these questions.
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Affiliation(s)
- Ahmed Babiker
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Joseph D Lutgring
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Scott Fridkin
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mary K Hayden
- Department of Internal Medicine (Infectious Diseases), Rush University Medical Center, Chicago, Illinois, USA.,Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
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8
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Abstract
Staphylococcus aureus infections are associated with increased morbidity, mortality, hospital stay, and health care costs. S aureus colonization has been shown to increase risk for invasive and noninvasive infections. Decolonization of S aureus has been evaluated in multiple patient settings as a possible strategy to decrease the risk of S aureus transmission and infection. In this article, we review the recent literature on S aureus decolonization in surgical patients, patients with recurrent skin and soft tissue infections, critically ill patients, hospitalized non-critically ill patients, dialysis patients, and nursing home residents to inform clinical practice.
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Affiliation(s)
- Sima L Sharara
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Lisa L Maragakis
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Sara E Cosgrove
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA.
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9
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O'Hara LM, Calfee DP, Miller LG, Pineles L, Magder LS, Johnson JK, Morgan DJ, Harris AD. Optimizing Contact Precautions to Curb the Spread of Antibiotic-resistant Bacteria in Hospitals: A Multicenter Cohort Study to Identify Patient Characteristics and Healthcare Personnel Interactions Associated With Transmission of Methicillin-resistant Staphylococcus aureus. Clin Infect Dis 2020; 69:S171-S177. [PMID: 31517979 PMCID: PMC6761365 DOI: 10.1093/cid/ciz621] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Healthcare personnel (HCP) acquire antibiotic-resistant bacteria on their gloves and gowns when caring for intensive care unit (ICU) patients. Yet, contact precautions for patients with methicillin-resistant Staphylococcus aureus (MRSA) remains controversial despite existing guidelines. We sought to understand which patients are more likely to transfer MRSA to HCP and to identify which HCP interactions are more likely to lead to glove or gown contamination. Methods This was a prospective, multicenter cohort study of cultured HCP gloves and gowns for MRSA. Samples were obtained from patients’ anterior nares, perianal area, and skin of the chest and arm to assess bacterial burden. Results Among 402 MRSA-colonized patients with 3982 interactions, we found that HCP gloves and gowns were contaminated with MRSA 14.3% and 5.9% of the time, respectively. Contamination of either gloves or gowns occurred in 16.2% of interactions. Contamination was highest among occupational/physical therapists (odds ratio [OR], 6.96; 95% confidence interval [CI], 3.51, 13.79), respiratory therapists (OR, 5.34; 95% CI, 3.04, 9.39), and when any HCP touched the patient (OR, 2.59; 95% CI, 1.04, 6.51). Touching the endotracheal tube (OR, 1.75; 95% CI, 1.38, 2.19), bedding (OR, 1.43; 95% CI, 1.20, 1.70), and bathing (OR, 1.32; 95% CI, 1.01, 1.75) increased the odds of contamination. We found an association between increasing bacterial burden on the patient and HCP glove or gown contamination. Conclusions Gloves and gowns are frequently contaminated with MRSA in the ICU. Hospitals may consider using fewer precautions for low-risk interactions and more for high-risk interactions and personnel.
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Affiliation(s)
- Lyndsay M O'Hara
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - David P Calfee
- Division of Infectious Diseases, Weill Cornell Medicine, New York, New York
| | - Loren G Miller
- LA BioMed at Harbor-University of California-Los Angeles Medical Center, Torrance
| | - Lisa Pineles
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Laurence S Magder
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - J Kristie Johnson
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore.,Department of Pathology, University of Maryland School of Medicine, Baltimore
| | - Daniel J Morgan
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Anthony D Harris
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
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10
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Liposomal mupirocin holds promise for systemic treatment of invasive Staphylococcus aureus infections. J Control Release 2019; 316:292-301. [DOI: 10.1016/j.jconrel.2019.11.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 11/07/2019] [Accepted: 11/08/2019] [Indexed: 01/05/2023]
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11
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The efficacy of very low-density sodium hypochloride washes in preventing healthcare-associated infections in pediatric intensive care units. JOURNAL OF SURGERY AND MEDICINE 2019. [DOI: 10.28982/josam.613450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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12
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Impact of decolonization on methicillin-resistant Staphylococcus aureus transmission and infection in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2019; 40:1123-1127. [PMID: 31362800 DOI: 10.1017/ice.2019.217] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The value of decolonization as a strategy for preventing methicillin-resistantStaphylococcus aureus (MRSA) in the neonatal intensive care unit (NICU) remains to be determined. OBJECTIVE After adding decolonization to further reduce MRSA transmission in our NICU, we conducted this retrospective review to evaluate its effectiveness. METHOD The review included patients who were admitted to our NICU between April 2015 and June 2018 and were eligible for decolonization including twice daily intranasal mupirocin and daily chlorhexidine gluconate bathing over 5 consecutive days. Patients were considered successfully decolonized if 3 subsequent MRSA screenings conducted at 1-week intervals were negative. The MRSA acquisition rate (AR) was calculated as hospital-acquired (HA) MRSA per 1,000 patient days (PD) and was used to measure the effectiveness of the decolonization. RESULTS Of the 151 MRSA patients being reviewed, 78 (51.6%) were HA-MRSA, resulting in an overall AR of 1.27 per 1,000 PD. Between April 2015 and February 2016, when only the decolonization was added, the AR was 2.38 per 1,000 PD. Between March 2016 and June 2018 after unit added a technician dedicated to the cleaning of reusable equipment, the AR decreased significantly to 0.92 per 1,000 PD (P < .05). Of the 78 patients who were started on the decolonization, 49 (62.8%) completed the protocol, 11 (14.1%) remained colonized, and 13 (16.7%) were recolonized prior to NICU discharge. CONCLUSION In a NICU with comprehensive MRSA prevention measures in place, enhancing the cleaning of reusable equipment, not decolonization, led to significant reduction of MRSA transmission.
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13
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Lee DH, Malat G, Boyle SM, Talluri S, Bias TE, Harhay MN, Ranganna K, Doyle A. Safety and Efficacy of Universal Postoperative Decolonization for Kidney Transplant Recipients. EXP CLIN TRANSPLANT 2019; 18:153-156. [PMID: 31266440 DOI: 10.6002/ect.2018.0341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Infection is a common cause of morbidity and mortality after kidney transplant. Based on the well-documented successes of reducing infections with decolonization of patients in intensive care units, we began a universal immediate posttransplant decolonization program for all kidney transplant recipients. Herein, we report safety and efficacy of this decolonization program. MATERIALS AND METHODS We compared a consecutive cohort of kidney transplant recipients who underwent universal decolonization (intervention group) with a cohort of transplant patients from an era immediately prior to this practice (control group). Universal decolonization included daily chlorhexidine body wash and nasal mupirocin ointment. RESULTS Seventy-eight patients who underwent universal decolonization were compared with 43 patients in the control group. Ten microbiologically proven infections (8.3%) occurred in the 30 days after discharge: 7 (9%) in the intervention group and 3 (7%) in the control group. Forty-five transplant recipients (37.2%) were readmitted in the 30 days after discharge: 31 (39.7%) in the intervention group and 14 (32.6%) in the control group. No patients in the intervention group had adverse drug events from mupirocin and chlorhexidine use. CONCLUSIONS A universal decolonization protocol was successfully implemented and was well tolerated by all patients. Despite successful implementation, we did not observe any significant differences in infection rates between treated patients and historical controls.
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Affiliation(s)
- Dong Heun Lee
- From the Division of Infectious Diseases and HIV Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
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14
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Xiao G, Chen Z, Lv X. Chlorhexidine-based body washing for colonization and infection of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus: an updated meta-analysis. Infect Drug Resist 2018; 11:1473-1481. [PMID: 30254478 PMCID: PMC6143131 DOI: 10.2147/idr.s170497] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background The effects of chlorhexidine-based body washing (CHW) on health care-associated infections have been reported in numerous studies, while their findings remain conflicting. This study aims to update the evidence for the effects of CHW on the risk of colonization or infection with hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE). Methods Two independent authors searched PubMed, Embase, and Cochrane Library from inception through February 2018. We selected all observational studies or clinical trials for the effect of CHW on the risk of colonization and infection with hospital-acquired MRSA or VRE. Random-effects models were applied to calculate summary incidence rate ratios (IRRs) for the related associations. Results Of 140 records identified, we obtained data from 17 relevant articles for meta-analysis. Compared with patients without antiseptic bathing, patients with CHW had a significantly lower risk of MRSA colonization (IRR 0.61, 95% CI 0.48–0.77) and VRE colonization (IRR 0.58, 95% CI 0.42–0.80). Similarly, we also noted that patients with CHW had a significantly lower risk of MRSA infection (IRR 0.65, 95% CI 0.52–0.81). However, no significantly lower risk of VRE infection (IRR 0.61, 95% CI 0.30–1.25) was noted in patients with CHW. Sensitivity analyses or trim-and-fill method confirmed the robustness of the findings. Conclusion Current evidence supports that patients with CHW had a significantly lower risk of MRSA or VRE colonization and a lower risk of MRSA infection. More evidence should be accumulated to reinforce these findings, especially on the effect of CHW on the risk of VRE infection.
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Affiliation(s)
- Guibao Xiao
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, Sichuan Province, People's Republic of China,
| | - Zhu Chen
- Public Health Clinic Center of Chengdu, Chengdu, Sichuan Province, People's Republic of China
| | - Xiaoju Lv
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, Sichuan Province, People's Republic of China,
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Hong J, Jang OJ, Bak MH, Baek EH, Park KH, Hong SI, Cho OH, Bae IG. Management of carbapenem-resistant Acinetobacter baumannii epidemic in an intensive care unit using multifaceted intervention strategy. Korean J Intern Med 2018; 33:1000-1007. [PMID: 29172401 PMCID: PMC6129627 DOI: 10.3904/kjim.2016.323] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 01/15/2017] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS We evaluated the effects of a multifaceted intervention for controlling a carbapenem-resistant Acinetobacter baumannii (CRAB) epidemic in an intensive care unit (ICU) with no restrictions on carbapenem use. METHODS This study was conducted in a medical ICU between April 2012 and June 2016. The baseline infection control programs included surveillance cultures, contact precautions, and environmental cleaning. However, increases in the detection of CRAB isolates beginning in May 2013 led to the implementation of a new protocol, consisting of universal glove and gown use with daily chlorhexidine bathing for all patients in combination with baseline programs. The efficacy of the intervention was subjected to interrupted time series (ITS) analysis. RESULTS The multifaceted intervention led to a decrease in the incidence of CRAB from 17.65 to 0.89 cases per 1,000 patient-days, during the study period (p < 0.001). ITS analysis revealed a significant change in the trend of CRAB incidence (-0.413, p < 0.001). Over this same period, mean monthly use of carbapenems increased from 143.54 ± 95.73 to 204.95 ± 78.43 doses per 1,000 patient-days (p = 0.018). CONCLUSION Our multifaceted intervention reduced the incidence of CRAB acquisition in an ICU where carbapenem use was not restricted.
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Affiliation(s)
- Jeongmin Hong
- Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Ok Jeom Jang
- Infection Control Office, Gyeongsang National University Hospital, Jinju, Korea
| | - Mi Hui Bak
- Infection Control Office, Gyeongsang National University Hospital, Jinju, Korea
| | - Eun Hwa Baek
- Infection Control Office, Gyeongsang National University Hospital, Jinju, Korea
| | - Ki-Ho Park
- Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Sun In Hong
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Oh-Hyun Cho
- Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea
- Infection Control Office, Gyeongsang National University Hospital, Jinju, Korea
- Correspondence to Oh-Hyun Cho, M.D. Department of Internal Medicine, Gyeongsang National University School of Medicine, 79 Gangnam-ro, Jinju 52727, Korea Tel: +82-55-750-8745 Fax: +82-55-755-9078 E-mail:
| | - In-Gyu Bae
- Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea
- Infection Control Office, Gyeongsang National University Hospital, Jinju, Korea
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Korea
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16
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Antimicrobial Resistance to Agents Used for Staphylococcus aureus Decolonization: Is There a Reason for Concern? Curr Infect Dis Rep 2018; 20:26. [PMID: 29882094 DOI: 10.1007/s11908-018-0630-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE OF REVIEW Chlorhexidine gluconate (CHG) and mupirocin are increasingly used for Staphylococcus aureus decolonization to prevent healthcare-associated infections; however, increased use of these agents has led to concerns for growing resistance and reduced efficacy. In this review, we describe current understanding of reduced susceptibility to CHG and mupirocin in S. aureus and their potential clinical implications. RECENT FINDINGS While emergence of S. aureus tolerant or resistant to topical antimicrobial agents used for decolonization is well described, the clinical impact of reduced susceptibility is not clear. Important challenges are that standardized methods of resistance testing and interpretation are not established, and the risk for selection for co- or cross-resistance using universal, as opposed to targeted decolonization, is unclear. Evidence continues to support S. aureus decolonization in certain patient groups, although further studies are needed to determine the long-term impact of CHG and mupirocin resistance on efficacy. Strategies to mitigate further development of reduced susceptibility and the consequences of selection pressures through universal decolonization on resistance will benefit from further investigation.
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17
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Henderson A, Nimmo GR. Control of healthcare- and community-associated MRSA: recent progress and persisting challenges. Br Med Bull 2018; 125:25-41. [PMID: 29190327 DOI: 10.1093/bmb/ldx046] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 10/31/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Healthcare adapted meticillin-resistant Staphylococcus aureus (MRSA) has spread to hospitals around the world over 50 years. More recently, other strains of MRSA have emerged with the ability to spread in the community and infect otherwise healthy individuals. Morbidity and mortality associated with MRSA remains high and its control in both the healthcare and community setting has proven challenging. SOURCES OF DATA Pubmed (Medline). AREAS OF AGREEMENT The use of targeted screening and decolonization, hand hygiene and antimicrobial stewardship is supported by the most robust studies, though many studies have implemented bundles for effective healthcare-associated (HA)-MRSA control. AREAS OF CONTENTION Universal screening, universal decolonization and contact precautions for HA-MRSA control are supported by less evidence. Some interventions may not be cost-effective. Contact precautions may be associated with potential for patient harm. Evidence for effective control community acquired (CA)-MRSA is largely lacking. GROWING POINTS Programmes that focus on implementing bundles of interventions aimed at targeting HA-MRSA are more likely to be effective, with an emphasis on hand hygiene as a key component. Control of CA-MRSA is likely to be more difficult to achieve and relies on prevalence, risk factors and community healthcare interactions on a broader scale. AREAS TIMELY FOR DEVELOPING RESEARCH Further research in the area of CA-MRSA in particular is required. Antimicrobial stewardship for both CA and HA-MRSA is promising, as is the role of whole genome sequencing in characterizing transmission. However, further work is required to assess their long-term roles in controlling MRSA. With many institutions applying widespread use of chlorhexidine washes, monitoring for chlorhexidine resistance is paramount to sustaining efforts at controlling MRSA.
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Affiliation(s)
- Andrew Henderson
- Infection Management Services, Princess Alexandra Hospital, Woolloongabba, Queensland 4102, Australia.,School of Chemistry and Molecular Biosciences, University of Queensland, St Lucia, Queensland 4067, Australia.,University of Queensland Centre for Clinical Research, Herston, Queensland 4029, Australia
| | - Graeme R Nimmo
- Pathology Queensland Central Laboratory, Herston, Queensland 4029, Australia.,School of Medicine, Griffith University, Southport 4222, Queensland, Australia
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Lee AS, Huttner B, Harbarth S. Prevention and Control of Methicillin-Resistant Staphylococcus aureus in Acute Care Settings. Infect Dis Clin North Am 2017; 30:931-952. [PMID: 27816144 DOI: 10.1016/j.idc.2016.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a leading cause of health care-associated infections worldwide. Controversies with regard to the effectiveness of various MRSA control strategies have contributed to varying approaches to the control of this pathogen in different settings. However, new evidence from large-scale studies has emerged, particularly with regards to MRSA screening and decolonization strategies, which will inform future control practices. The implementation as well as outcomes of control measures in the real world is not only influenced by scientific evidence but also depends on economic, administrative, governmental, and political influences.
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Affiliation(s)
- Andie S Lee
- Departments of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Missenden Road, Camperdown, Sydney, New South Wales 2050, Australia.
| | - Benedikt Huttner
- Infection Control Programme, University of Geneva Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva CH-1205, Switzerland; Division of Infectious Diseases, University of Geneva Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva CH-1205, Switzerland
| | - Stephan Harbarth
- Infection Control Programme, University of Geneva Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva CH-1205, Switzerland
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Cho OH, Park KH, Song JY, Hong JM, Kim T, Hong SI, Kim S, Bae IG. Prevalence and Microbiological Characteristics of qacA/B-Positive Methicillin-Resistant Staphylococcus aureus Isolates in a Surgical Intensive Care Unit. Microb Drug Resist 2017; 24:283-289. [PMID: 28799881 DOI: 10.1089/mdr.2017.0072] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The increasing use of chlorhexidine for methicillin-resistant Staphylococcus aureus (MRSA) decolonization has raised concerns about the emergence of resistance to or tolerance of this antiseptic. We examined the frequency and characteristics of qacA/B chlorhexidine tolerance genes among MRSA isolates in a surgical intensive care unit (ICU) where MRSA-colonized patients are decolonized by chlorhexidine bathing. The MRSA isolates were evaluated for chlorhexidine susceptibility, mupirocin resistance, molecular typing, agr functionality, and the heterogeneous vancomycin-intermediate S. aureus (hVISA) phenotype according to the presence of the qacA/B genes. Overall, 119 MRSA isolates were obtained from active surveillance cultures (93, 78.2%) and clinical cultures (26, 21.8%) between 2012 and 2014. Among these isolates, 39 (32.8%) carried the qacA/B genes, and 23 (19.3%) exhibited mupirocin resistance. Most qacA/B-positive isolates (36/39, 92.3%) were identified as ST5-SCCmecII (69.2%) and ST239-SCCmecIII (23.1%), which are common healthcare-associated (HA)-MRSA strains in Korea. Multivariate analysis found that qacA/B-positive MRSA isolates were associated with agr dysfunction (OR, 4.87; 95% CI, 1.71-13.87) and the hVISA phenotype (OR, 4.09; 95% CI, 1.48-11.34). In conclusion, our study showed that qacA/B carriage was common among MRSA isolates in an ICU where chlorhexidine is commonly used for decolonization. qacA/B carriage was significantly associated with agr dysfunction and the hVISA phenotype. These features may confer a selective advantage on HA-MRSA strains, including ST5-SCCmecII and ST239-SCCmecIII, in the ICU setting.
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Affiliation(s)
- Oh-Hyun Cho
- 1 Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine , Jinju, Republic of Korea
| | - Ki-Ho Park
- 2 Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine , Seoul, Republic of Korea
| | - Ji Young Song
- 1 Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine , Jinju, Republic of Korea
| | - Jeong Min Hong
- 1 Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine , Jinju, Republic of Korea
| | - Taeeun Kim
- 1 Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine , Jinju, Republic of Korea
| | - Sun In Hong
- 3 Department of Internal Medicine, Gyeongsang National University Changwon Hospital , Changwon, Republic of Korea
| | - Sunjoo Kim
- 4 Department of Laboratory Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine , Jinju, Republic of Korea.,5 Gyeongsang Institute of Health Sciences, Gyeongsang National University School of Medicine , Jinju, Republic of Korea
| | - In-Gyu Bae
- 1 Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine , Jinju, Republic of Korea.,5 Gyeongsang Institute of Health Sciences, Gyeongsang National University School of Medicine , Jinju, Republic of Korea
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Antimicrobial Selection in the Face of Nasal Methicillin-Resistant Staphylococcus aureus-Polymerase Chain Recombination Testing in Thermal Injury Patients. J Burn Care Res 2016; 37:115-21. [PMID: 26182073 DOI: 10.1097/bcr.0000000000000173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Emergence of resistance to vancomycin and the increasing incidence of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) warrant careful initiation of antimicrobial agents after nasal swab polymerase chain recombination (PCR) MRSA positive screen. Current MRSA PCR nasal swab (PCR) screening does not distinguish non-hospital-acquired strains. A retrospective, institutional review board-approved study of collected PCR screenings among 826 burn center admissions over a 23-month period assessed culture results, antimicrobial agents chosen, and patient demographics. Seventy-seven of the 826 were known chronic carriers (n = 11); had MRSA on initial PCR (n = 48); or converted to positive PCR screen on later testing (n = 18). The 48 patients with initial positive PCR were decolonized with mupirocin. MRSA carriers were not decolonized. The 18 patients who became PCR positive were also not decolonized with 10 having positive cultures. The 48 initial PCR nasal swab positive patients represented 5.8% of admissions. Demographic data did not differ among chronic carriers, initial PCR positive patients, nor those converting to PCR positive. Length of stay was shorter for initial PCR positive decolonized patients (P << .05) and they had a 35% of decrease in MRSA infection. All 11 chronic carriers became infected with MRSA; however, five had non-hospital-acquired MRSA and two solely non-hospital-acquired MRSA. For the 48 PCR positive patients, 17 had isolated MRSA and one having exclusively non-hospital-acquired MRSA. Of the 39 patients with isolated MRSA, 20 (43%) non-hospital-acquired MRSA. Non-hospital-acquired MRSA was 43%, however PCR fails to distinguish hospital-acquired MRSA from community-acquired MRSA.
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Effectiveness of Chlorhexidine Wipes for the Prevention of Multidrug-Resistant Bacterial Colonization and Hospital-Acquired Infections in Intensive Care Unit Patients: A Randomized Trial in Thailand. Infect Control Hosp Epidemiol 2016; 37:245-53. [PMID: 26894621 DOI: 10.1017/ice.2015.285] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To determine the effectiveness of daily bathing with 2% chlorhexidine-impregnated washcloths in preventing multidrug-resistant (MDR) gram-positive bacterial colonization and bloodstream infection. METHODS A randomized, open-label controlled trial was conducted in 4 medical intensive care units (ICUs) in Thailand from December 2013 to January 2015. Patients were randomized to receive cleansing with non-antimicrobial soap (control group) or 2% chlorhexidine-impregnated washcloths used to wipe the patient's body once daily (chlorhexidine group). Swabs were taken from nares, axilla, antecubital, groin, and perianal areas on admission and on day 3, 5, 7, and 14. The 5 outcomes were (1) favorable events ( all samples negative throughout ICU admission, or initially positive samples with subsequent negative samples); (2) MDR bacteria colonization-free time; (3) hospital-acquired infection; (4) length of ICU and hospital stay; (5) adverse skin reactions. RESULTS A total of 481 patients were randomly assigned to the control group (241) or the chlorhexidine group (240). Favorable events at day 14 were observed in 34.8% of patients in the control group and 28.6% in the chlorhexidine group (P=.79). Median MDR bacteria colonization-free times were 5 days in both groups. The incidence rate of hospital-acquired infection and the length of the ICU and hospital stay did not differ significantly between groups. The incidence of adverse skin reactions in the chlorhexidine group was 2.5%. CONCLUSION The effectiveness of 2% chlorhexidine-impregnated washcloths for the prevention of MDR gram-negative bacteria colonization and hospital-acquired infection in adult patients in ICU was not proven. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01989416.
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Effect of daily chlorhexidine bathing on the acquisition of methicillin-resistant Staphylococcus aureus in a medical intensive care unit with methicillin-resistant S aureus endemicity. Am J Infect Control 2016; 44:1520-1525. [PMID: 27520786 DOI: 10.1016/j.ajic.2016.04.252] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 04/27/2016] [Accepted: 04/27/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Universal decolonization is recommended in intensive care units (ICUs) that have unacceptably high rates of methicillin-resistant Staphylococcus aureus (MRSA) despite implementation of basic prevention strategies. METHODS An interrupted time series study was performed to evaluate the effect of daily chlorhexidine bathing on the acquisition of MRSA in a medical ICU with MRSA endemicity. There was a 14-month control period and a 16-month chlorhexidine bathing period. Segmented Poisson regression analysis was performed to assess the impact of daily chlorhexidine bathing on the incidence density of MRSA. Also, chlorhexidine susceptibility testing with polymerase chain reaction for the qacA/B gene was performed on MRSA isolates collected during the chlorhexidine bathing period. RESULTS There was a significant reduction in trend (-0.056; 95% confidence interval, -0.095 to -0.017; P = .005) of incidence density of MRSA despite a significant increase in both level and trend of MRSA prevalence rates during the chlorhexidine bathing period. However, there was no significant reduction in level of incidence density of MRSA during the interventional period. Minimum inhibitory concentration of chlorhexidine and the detection rates of the qacA/B gene for a total of 174 MRSA isolates did not increase during the chlorhexidine bathing period. CONCLUSIONS Daily chlorhexidine bathing resulted in a significantly decreasing trend of MRSA acquisition rates irrespective of increased MRSA prevalence rates in the medical ICU. There was no shift of chlorhexidine-resistant MRSA strains.
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Küçükdurmaz F, Parvizi J. The Prevention of Periprosthetic Joint Infections. Open Orthop J 2016; 10:589-599. [PMID: 28144372 PMCID: PMC5226971 DOI: 10.2174/1874325001610010589] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 06/12/2016] [Accepted: 07/15/2016] [Indexed: 12/14/2022] Open
Abstract
Periprosthetic joint infection (PJI) following total joint arthroplasty (TJA) adversely affects patient quality of life and health status, and places a huge financial burden on the health care. The first step in combating this complication is prevention, which may include implementation of strategies during the preoperative, intraoperative, or postoperative period. Optimization of the patient with appreciation of the modifiable and non-modifiable factors is crucial. Preoperative optimization involves medical optimization of patients with comorbidities such as diabetes, anemia, malnutrition and other conditions that may predispose the patient to PJI. Among the intraoperative strategies, administration of appropriate and timely antibiotics, blood conservation, gentle soft tissue handling, and expeditious surgery in an ultra clean operating room are among the most effective strategies. During the postoperative period, all efforts should be made to minimize ingress or proliferation of bacteria at the site of the index arthroplasty from draining the wound and hematoma formation. Although the important role of some preventative measures is known, further research is needed to evaluate the role of unproven measures that are currently employed and to devise further strategies for prevention of this feared complication.
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Affiliation(s)
- Fatih Küçükdurmaz
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Javad Parvizi
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Abstract
Colonization with health care-associated pathogens such as Staphylococcus aureus, enterococci, Gram-negative organisms, and Clostridium difficile is associated with increased risk of infection. Decolonization is an evidence-based intervention that can be used to prevent health care-associated infections (HAIs). This review evaluates agents used for nasal topical decolonization, topical (e.g., skin) decolonization, oral decolonization, and selective digestive or oropharyngeal decontamination. Although the majority of studies performed to date have focused on S. aureus decolonization, there is increasing interest in how to apply decolonization strategies to reduce infections due to Gram-negative organisms, especially those that are multidrug resistant. Nasal topical decolonization agents reviewed include mupirocin, bacitracin, retapamulin, povidone-iodine, alcohol-based nasal antiseptic, tea tree oil, photodynamic therapy, omiganan pentahydrochloride, and lysostaphin. Mupirocin is still the gold standard agent for S. aureus nasal decolonization, but there is concern about mupirocin resistance, and alternative agents are needed. Of the other nasal decolonization agents, large clinical trials are still needed to evaluate the effectiveness of retapamulin, povidone-iodine, alcohol-based nasal antiseptic, tea tree oil, omiganan pentahydrochloride, and lysostaphin. Given inferior outcomes and increased risk of allergic dermatitis, the use of bacitracin-containing compounds cannot be recommended as a decolonization strategy. Topical decolonization agents reviewed included chlorhexidine gluconate (CHG), hexachlorophane, povidone-iodine, triclosan, and sodium hypochlorite. Of these, CHG is the skin decolonization agent that has the strongest evidence base, and sodium hypochlorite can also be recommended. CHG is associated with prevention of infections due to Gram-positive and Gram-negative organisms as well as Candida. Conversely, triclosan use is discouraged, and topical decolonization with hexachlorophane and povidone-iodine cannot be recommended at this time. There is also evidence to support use of selective digestive decontamination and selective oropharyngeal decontamination, but additional studies are needed to assess resistance to these agents, especially selection for resistance among Gram-negative organisms. The strongest evidence for decolonization is for use among surgical patients as a strategy to prevent surgical site infections.
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Strategies to Prevent Methicillin-ResistantStaphylococcus aureusTransmission and Infection in Acute Care Hospitals: 2014 Update. Infect Control Hosp Epidemiol 2016; 35 Suppl 2:S108-32. [DOI: 10.1017/s0899823x00193882] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their methicillin-resistantStaphylococcus aureus(MRSA) prevention efforts. This document updates “Strategies to Prevent Transmission of Methicillin-ResistantStaphylococcus aureusin Acute Care Hospitals,” published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.
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Cho OH, Baek EH, Bak MH, Suh YS, Park KH, Kim S, Bae IG, Lee SH. The effect of targeted decolonization on methicillin-resistant Staphylococcus aureus colonization or infection in a surgical intensive care unit. Am J Infect Control 2016; 44:533-8. [PMID: 26847518 DOI: 10.1016/j.ajic.2015.12.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 12/03/2015] [Accepted: 12/07/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND The effect of decolonization on the control of methicillin-resistant Staphylococcus aureus (MRSA) may differ depending on intensive care unit (ICU) settings and the prevalence of antiseptic resistance in MRSA. METHODS This study was conducted in a 14-bed surgical ICU over a 40-month period. The baseline period featured active surveillance for MRSA and institution of contact precautions. MRSA decolonization via chlorhexidine baths and intranasal mupirocin was implemented during a subsequent 20-month intervention period. Pre-post and interrupted time series analysis were used to evaluate changes in the clinical incidence of hospital-acquired MRSA colonization or infection. MRSA isolates were tested for the presence of qacA/B genes and mupirocin resistance. RESULTS In pre-post analysis, the clinical incidence of MRSA significantly decreased by 61.6% after implementation of decolonization (P < .001). Meanwhile, interrupted time series analysis showed decreases in both the level (β = -0.686; P = .210) and trend (β = -0.011; P = .819) of clinical MRSA incidence, but these changes were not statistically significant. Of 169 MRSA isolates, 64 (37.8%) carried the qacA/B genes, and 22 (13.0%) showed either low- (n = 20) or high-level (n = 2) resistance to mupirocin. Low-level mupirocin resistance significantly increased from 0%-19.4% during the study period. CONCLUSION Although decolonization using antiseptic agents was helpful to decrease hospital-acquired MRSA rates, the emergence of antiseptic resistance should be monitored.
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Petlin A, Schallom M, Prentice D, Sona C, Mantia P, McMullen K, Landholt C. Chlorhexidine gluconate bathing to reduce methicillin-resistant Staphylococcus aureus acquisition. Crit Care Nurse 2016; 34:17-25; quiz 26. [PMID: 25274761 DOI: 10.4037/ccn2014943] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) is a virulent organism causing substantial morbidity and mortality in intensive care units. Chlorhexidine gluconate, a topical antiseptic solution, is effective against a wide spectrum of gram-positive and gram-negative bacteria, including MRSA. Objectives To examine the impact of a bathing protocol using chlorhexidine gluconate and bath basin management on MRSA acquisition in 5 adult intensive care units and to examine the cost differences between chlorhexidine bathing by using the bath-basin method versus using prepackaged chlorhexidine-impregnated washcloths. METHODS The protocol used a 4-oz bottle of 4% chlorhexidine gluconate soap in a bath basin of warm water. Patients in 3 intensive care units underwent active surveillance for MRSA acquisition; patients in 2 other units were monitored for a new positive culture for MRSA at any site 48 hours after admission. RESULTS Before the protocol, 132 patients acquired MRSA in 34333 patient days (rate ratio, 3.84). Afterwards, 109 patients acquired MRSA in 41376 patient days (rate ratio, 2.63). The rate ratio difference is 1.46 (95% CI, 1.12-1.90; P = .003). The chlorhexidine soap and bath basin method cost $3.18 as compared with $5.52 for chlorhexidine-impregnated wipes (74% higher). CONCLUSIONS The chlorhexidine bathing protocol is easy to implement, cost-effective, and led to decreased unit-acquired MRSA rates in a variety of adult intensive care units.
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Affiliation(s)
- Ann Petlin
- Ann Petlin is a clinical nurse specialist in the cardiothoracic intensive care unit at Barnes-Jewish Hospital, St Louis, Missouri.Marilyn (Lynn) Schallom is a clinical nurse specialist and research scientist in the Department of Research for Patient Care Services at Barnes-Jewish Hospital.Donna Prentice is a clinical nurse specialist in a medical intensive care unit at Barnes-Jewish Hospital.Carrie Sona is a clinical nurse specialist in the surgery/burns/trauma intensive care unit at Barnes-Jewish Hospital.Paula Mantia is the advanced practice nurse in a medical intensive care unit at Barnes-Jewish Hospital.Kathleen McMullen is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital.Cassandra (Casey) Landholt is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital.
| | - Marilyn Schallom
- Ann Petlin is a clinical nurse specialist in the cardiothoracic intensive care unit at Barnes-Jewish Hospital, St Louis, Missouri.Marilyn (Lynn) Schallom is a clinical nurse specialist and research scientist in the Department of Research for Patient Care Services at Barnes-Jewish Hospital.Donna Prentice is a clinical nurse specialist in a medical intensive care unit at Barnes-Jewish Hospital.Carrie Sona is a clinical nurse specialist in the surgery/burns/trauma intensive care unit at Barnes-Jewish Hospital.Paula Mantia is the advanced practice nurse in a medical intensive care unit at Barnes-Jewish Hospital.Kathleen McMullen is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital.Cassandra (Casey) Landholt is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital
| | - Donna Prentice
- Ann Petlin is a clinical nurse specialist in the cardiothoracic intensive care unit at Barnes-Jewish Hospital, St Louis, Missouri.Marilyn (Lynn) Schallom is a clinical nurse specialist and research scientist in the Department of Research for Patient Care Services at Barnes-Jewish Hospital.Donna Prentice is a clinical nurse specialist in a medical intensive care unit at Barnes-Jewish Hospital.Carrie Sona is a clinical nurse specialist in the surgery/burns/trauma intensive care unit at Barnes-Jewish Hospital.Paula Mantia is the advanced practice nurse in a medical intensive care unit at Barnes-Jewish Hospital.Kathleen McMullen is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital.Cassandra (Casey) Landholt is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital
| | - Carrie Sona
- Ann Petlin is a clinical nurse specialist in the cardiothoracic intensive care unit at Barnes-Jewish Hospital, St Louis, Missouri.Marilyn (Lynn) Schallom is a clinical nurse specialist and research scientist in the Department of Research for Patient Care Services at Barnes-Jewish Hospital.Donna Prentice is a clinical nurse specialist in a medical intensive care unit at Barnes-Jewish Hospital.Carrie Sona is a clinical nurse specialist in the surgery/burns/trauma intensive care unit at Barnes-Jewish Hospital.Paula Mantia is the advanced practice nurse in a medical intensive care unit at Barnes-Jewish Hospital.Kathleen McMullen is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital.Cassandra (Casey) Landholt is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital
| | - Paula Mantia
- Ann Petlin is a clinical nurse specialist in the cardiothoracic intensive care unit at Barnes-Jewish Hospital, St Louis, Missouri.Marilyn (Lynn) Schallom is a clinical nurse specialist and research scientist in the Department of Research for Patient Care Services at Barnes-Jewish Hospital.Donna Prentice is a clinical nurse specialist in a medical intensive care unit at Barnes-Jewish Hospital.Carrie Sona is a clinical nurse specialist in the surgery/burns/trauma intensive care unit at Barnes-Jewish Hospital.Paula Mantia is the advanced practice nurse in a medical intensive care unit at Barnes-Jewish Hospital.Kathleen McMullen is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital.Cassandra (Casey) Landholt is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital
| | - Kathleen McMullen
- Ann Petlin is a clinical nurse specialist in the cardiothoracic intensive care unit at Barnes-Jewish Hospital, St Louis, Missouri.Marilyn (Lynn) Schallom is a clinical nurse specialist and research scientist in the Department of Research for Patient Care Services at Barnes-Jewish Hospital.Donna Prentice is a clinical nurse specialist in a medical intensive care unit at Barnes-Jewish Hospital.Carrie Sona is a clinical nurse specialist in the surgery/burns/trauma intensive care unit at Barnes-Jewish Hospital.Paula Mantia is the advanced practice nurse in a medical intensive care unit at Barnes-Jewish Hospital.Kathleen McMullen is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital.Cassandra (Casey) Landholt is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital
| | - Cassandra Landholt
- Ann Petlin is a clinical nurse specialist in the cardiothoracic intensive care unit at Barnes-Jewish Hospital, St Louis, Missouri.Marilyn (Lynn) Schallom is a clinical nurse specialist and research scientist in the Department of Research for Patient Care Services at Barnes-Jewish Hospital.Donna Prentice is a clinical nurse specialist in a medical intensive care unit at Barnes-Jewish Hospital.Carrie Sona is a clinical nurse specialist in the surgery/burns/trauma intensive care unit at Barnes-Jewish Hospital.Paula Mantia is the advanced practice nurse in a medical intensive care unit at Barnes-Jewish Hospital.Kathleen McMullen is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital.Cassandra (Casey) Landholt is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital
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Plantinga NL, Wittekamp BHJ, van Duijn PJ, Bonten MJM. Fighting antibiotic resistance in the intensive care unit using antibiotics. Future Microbiol 2016; 10:391-406. [PMID: 25812462 DOI: 10.2217/fmb.14.146] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Antibiotic resistance is a global and increasing problem that is not counterbalanced by the development of new therapeutic agents. The prevalence of antibiotic resistance is especially high in intensive care units with frequently reported outbreaks of multidrug-resistant organisms. In addition to classical infection prevention protocols and surveillance programs, counterintuitive interventions, such as selective decontamination with antibiotics and antibiotic rotation have been applied and investigated to control the emergence of antibiotic resistance. This review provides an overview of selective oropharyngeal and digestive tract decontamination, decolonization of methicillin-resistant Staphylococcus aureus and antibiotic rotation as strategies to modulate antibiotic resistance in the intensive care unit.
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Affiliation(s)
- Nienke L Plantinga
- Julius Center for Epidemiology of Infectious Disease, University Medical Center Utrecht, Utrecht, The Netherlands
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The Impact of a Universal Decolonization Protocol on Hospital-Acquired Methicillin-Resistant Staphylococcus aureus in a Burn Population. J Burn Care Res 2016; 37:e525-e530. [DOI: 10.1097/bcr.0000000000000301] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sai N, Laurent C, Strale H, Denis O, Byl B. Efficacy of the decolonization of methicillin-resistant Staphylococcus aureus carriers in clinical practice. Antimicrob Resist Infect Control 2015; 4:56. [PMID: 26688720 PMCID: PMC4683972 DOI: 10.1186/s13756-015-0096-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 11/26/2015] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Nasal and extra nasal carriage of methicillin-resistant S. aureus (MRSA) is a pre-existing condition that often leads to invasive MRSA infection, as MRSA colonization is associated with a high risk of acquiring MRSA infection during hospital stays. Decolonization may reduce the risk of meticillin-resistant Staphylococcus aureus (MRSA) infection in individual carriers and prevent transmission to other patients. METHODS A retrospective cohort study was conducted to evaluate the effectiveness of two decolonization protocols for newly diagnosed MRSA carriage in hospitalized patients and to assess the impact of decolonization on the rate of MRSA infection. The study population consisted of all patients diagnosed as MRSA-positive between January 2006 and June 2010. Patients diagnosed as carriers were designated as requiring contact precautions by the hospital infection control team. The standing order protocol of the hospital pertaining to decolonization procedures was then applied, and all newly diagnosed patients were administered one of the two decolonization treatments outlined in the hospital protocol, with the exception of MRSA respiratory carriers (MRSA obtained from sputum or other lower respiratory tract samples). The two decolonization treatments consisted of the application of intranasal mupirocin 2 % and washing with chlorhexidine soap (40 mg/mL) (mupi/CHX) or application of intranasal povidone-iodine and washing with povidone-iodine soap (PVPI), with each treatment lasting for 5 days. Success was determined by at least three successive nose swabs and throat and other screened site swabs that tested negative for MRSA before patient discharge. RESULTS A total of 1150 patients admitted to the hospital were found to be infected or colonized with MRSA. Of the 1150 patients, 268 were prescribed decolonization treatment. 104 out of 268 patients (39 %) were successfully decolonized. There was no significant success after two decolonization failures. MRSA infection rate among the successes and failures were 0.0 and 4.3 %, respectively [P = 0.04]. CONCLUSIONS Our results fit well with the prescription of decolonization based on local strategy protocols but reflect a low rate of successful treatment. Although the success rate of decolonization was not high in our study, the effectiveness of decolonization on the infection rate, justifies the continuation of this strategy, even if a marginal cost is incurred.
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Affiliation(s)
- N Sai
- Hospital Epidemiology and Infection Control Unit, Erasme Hospital, Université Libre de Bruxelles, 808, Route de Lennik, 1070 Brussels, Belgium
| | - C Laurent
- Hygiène Hospitalière, Centre Hospitalier Régional de Namur, Namur, Belgium
| | - H Strale
- Hospital Epidemiology and Infection Control Unit, Erasme Hospital, Université Libre de Bruxelles, 808, Route de Lennik, 1070 Brussels, Belgium
| | - O Denis
- Department of Clinical Microbiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium ; School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - B Byl
- Hospital Epidemiology and Infection Control Unit, Erasme Hospital, Université Libre de Bruxelles, 808, Route de Lennik, 1070 Brussels, Belgium ; School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
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Clinical and Molecular Features of Decreased Chlorhexidine Susceptibility among Nosocomial Staphylococcus aureus Isolates at Texas Children's Hospital. Antimicrob Agents Chemother 2015; 60:1121-8. [PMID: 26666947 DOI: 10.1128/aac.02011-15] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 12/03/2015] [Indexed: 01/18/2023] Open
Abstract
One of the strategies utilized to decrease infections in the hospital setting relies on topical antimicrobials and antiseptics. While their use is beneficial, concerns arise over the potential to develop resistance or tolerance to these agents. We examined nosocomial Staphylococcus aureus isolates from 2007 to 2013 for the presence of genes associated with tolerance to chlorhexidine. Isolates and patients were identified from an S. aureus surveillance study at Texas Children's Hospital. Nosocomial S. aureus isolates (those causing infection at ≥72 h of hospitalization) were identified and underwent PCR for the qacA or qacB (qacA/B) and smr genes associated with elevated minimum bactericidal concentrations of chlorhexidine. Molecular typing with pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST), and agr typing and a review of the medical record were performed. Two hundred forty-seven nosocomial S. aureus infections were identified. Overall, 111 isolates carried one or both genes (44.9%); 33.1% were positive for smr, 22.7% were positive for qacA/B, and 10.9% of the isolates possessed both genes. The smr-positive isolates were more often resistant to methicillin, ciprofloxacin, and/or clindamycin. The isolates positive for qacA/B were more often associated with indwelling central venous catheters and a vancomycin MIC of ≥2 μg/ml. Isolates carrying either smr or qacA/B were associated with a diagnosis of bacteremia. The smr-positive isolates more often belonged to sequence type 8 (ST8) than the isolates that were positive for qacA/B. Mupirocin resistance was detected in 2.8% of the isolates. Antiseptic-tolerant S. aureus strains are common in our children's hospital and are associated with decreased susceptibility to other systemic antimicrobials and with bloodstream infections. Further work is needed to understand the implications that these organisms have on the hospital environment and antiseptic use in the future.
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Effect of daily chlorhexidine bathing on acquisition of carbapenem-resistant Acinetobacter baumannii (CRAB) in the medical intensive care unit with CRAB endemicity. Am J Infect Control 2015; 43:1171-7. [PMID: 26297525 DOI: 10.1016/j.ajic.2015.07.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 06/26/2015] [Accepted: 07/01/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND There is insufficient evidence for daily chlorhexidine bathing to reduce nosocomial spread of carbapenem-resistant Acinetobacter baumannii (CRAB) in endemic situations. METHODS An interrupted time series study was performed to evaluate the effect of daily chlorhexidine bathing on the acquisition of CRAB in a medical intensive care unit (ICU) with CRAB endemicity. There was a 14-month control period and 12-month chlorhexidine bathing period. Segmented Poisson regression analysis was performed to assess the impact of chlorhexidine bathing on the level and trend of the series of prevalence rates and incidence density. Also, chlorhexidine susceptibility testing was performed on CRAB isolates collected during the chlorhexidine bathing period. RESULTS There was a 51.8% reduction of CRAB acquisition rates after an introduction of daily chlorhexidine bathing (44.0 vs 21.2 cases/1,000 at-risk patient days, P < .001). There was a significant reduction in the level (-0.604; 95% CI, -0.904 to -0.305; P < .001) of incidence density of CRAB, whereas there was no significant change in both level and trend of CRAB prevalence rates. Minimum inhibitory concentration of chlorhexidine against a total of 98 CRAB isolates ranged from 8-64 μg/mL. CONCLUSION Daily chlorhexidine bathing significantly reduces the acquisition of CRAB in a medical ICU with CRAB endemicity.
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Effectiveness of meticillin-resistant Staphylococcus aureus decolonization in long-term haemodialysis patients: a systematic review and meta-analysis. J Hosp Infect 2015; 91:250-6. [DOI: 10.1016/j.jhin.2015.08.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 08/04/2015] [Indexed: 11/19/2022]
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Cost-effectiveness of strategies to prevent methicillin-resistant Staphylococcus aureus transmission and infection in an intensive care unit. Infect Control Hosp Epidemiol 2015; 36:17-27. [PMID: 25627757 DOI: 10.1017/ice.2014.12] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To create a national policy model to evaluate the projected cost-effectiveness of multiple hospital-based strategies to prevent methicillin-resistant Staphylococcus aureus (MRSA) transmission and infection. DESIGN Cost-effectiveness analysis using a Markov microsimulation model that simulates the natural history of MRSA acquisition and infection. PATIENTS AND SETTING Hypothetical cohort of 10,000 adult patients admitted to a US intensive care unit. METHODS We compared 7 strategies to standard precautions using a hospital perspective: (1) active surveillance cultures; (2) active surveillance cultures plus selective decolonization; (3) universal contact precautions (UCP); (4) universal chlorhexidine gluconate baths; (5) universal decolonization; (6) UCP + chlorhexidine gluconate baths; and (7) UCP+decolonization. For each strategy, both efficacy and compliance were considered. Outcomes of interest were: (1) MRSA colonization averted; (2) MRSA infection averted; (3) incremental cost per colonization averted; (4) incremental cost per infection averted. RESULTS A total of 1989 cases of colonization and 544 MRSA invasive infections occurred under standard precautions per 10,000 patients. Universal decolonization was the least expensive strategy and was more effective compared with all strategies except UCP+decolonization and UCP+chlorhexidine gluconate. UCP+decolonization was more effective than universal decolonization but would cost $2469 per colonization averted and $9007 per infection averted. If MRSA colonization prevalence decreases from 12% to 5%, active surveillance cultures plus selective decolonization becomes the least expensive strategy. CONCLUSIONS Universal decolonization is cost-saving, preventing 44% of cases of MRSA colonization and 45% of cases of MRSA infection. Our model provides useful guidance for decision makers choosing between multiple available hospital-based strategies to prevent MRSA transmission.
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Nair R, Perencevich EN, Blevins AE, Goto M, Nelson RE, Schweizer ML. Clinical Effectiveness of Mupirocin for Preventing Staphylococcus aureus Infections in Nonsurgical Settings: A Meta-analysis. Clin Infect Dis 2015; 62:618-630. [PMID: 26503378 DOI: 10.1093/cid/civ901] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 10/16/2015] [Indexed: 11/15/2022] Open
Abstract
A systematic literature review and meta-analysis was performed to identify effectiveness of mupirocin decolonization in prevention of Staphylococcus aureus infections, among nonsurgical settings. Of the 15 662 unique studies identified up to August 2015, 13 randomized controlled trials, 22 quasi-experimental studies, and 1 retrospective cohort study met the inclusion criteria. Studies were excluded if mupirocin was not used for decolonization, there was no control group, or the study was conducted in an outbreak setting. The crude risk ratios were pooled (cpRR) using a random-effects model. We observed substantial heterogeneity among included studies (I(2) = 80%). Mupirocin was observed to reduce the risk for S. aureus infections by 59% (cpRR, 0.41; 95% confidence interval [CI], .36-.48) and 40% (cpRR, 0.60; 95% CI, .46-.79) in both dialysis and nondialysis settings, respectively. Mupirocin decolonization was protective against S. aureus infections among both dialysis and adult intensive care patients. Future studies are needed in other settings such as long-term care and pediatrics.
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Affiliation(s)
- Rajeshwari Nair
- Department of Epidemiology, University of Iowa College of Public Health.,Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System.,Department of Internal Medicine, University of Iowa Carver College of Medicine
| | - Eli N Perencevich
- Department of Epidemiology, University of Iowa College of Public Health.,Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System.,Department of Internal Medicine, University of Iowa Carver College of Medicine
| | - Amy E Blevins
- Hardin Library for Health Sciences, University of Iowa, Iowa City
| | - Michihiko Goto
- Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System.,Department of Internal Medicine, University of Iowa Carver College of Medicine
| | - Richard E Nelson
- IDEAS Center, Veterans Affairs Salt Lake City Health Care System, Utah
| | - Marin L Schweizer
- Department of Epidemiology, University of Iowa College of Public Health.,Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System.,Department of Internal Medicine, University of Iowa Carver College of Medicine
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Liu Q, Zhao H, Han L, Shu W, Wu Q, Ni Y. Frequency of biocide-resistant genes and susceptibility to chlorhexidine in high-level mupirocin-resistant, methicillin-resistant Staphylococcus aureus (MuH MRSA). Diagn Microbiol Infect Dis 2015; 82:278-83. [DOI: 10.1016/j.diagmicrobio.2015.03.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 03/14/2015] [Accepted: 03/22/2015] [Indexed: 12/11/2022]
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Geofrey A, Abade A, Aboud S. Methicillin-resistant staphylococcus aureus (MRSA) colonization among Intensive Care Unit (ICU) patients and health care workers at Muhimbili national hospital, Dar Es Salaam, Tanzania, 2012. Pan Afr Med J 2015; 21:211. [PMID: 26448806 PMCID: PMC4587086 DOI: 10.11604/pamj.2015.21.211.4207] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 01/08/2015] [Indexed: 11/26/2022] Open
Abstract
Introduction Methicillin-resistant Staphylococcus aureus (MRSA) has been recognized as important nosocomial pathogens worldwide. S aureus may induce clinically manifested diseases, or the host may remain completely asymptomatic. Methods A cross-sectional hospital-based study was conducted from October 2012 to March 2013 in two ICUs at MNH. Admitted patients and health care workers were enrolled in the study. Interviewer administered questionnaires; patient history forms, observation charts and case report forms were used to collect data. Swabs (nostrils, axillary or wounds) were collected. MRSA were screened and confirmed using cefoxitin, oxacillin discs and oxacillin screen agar. Antibiotic susceptibility was performed using Kirby-Bauer disk diffusion method. The risk factors for MRSA were determined using the logistic regression analysis and a p - value of <0.05 was considered as statistically significant. Results Of the 169 patients and 47 health workers who were recruited, the mean age was 43.4 years ± SD 15.3 and 37.7 years ± (SD) 11.44 respectively. Among the patients male contributed 108 (63.9%) while in health worker majority 39(83%) were females. The prevalence of MRSA colonization among patients and health care workers was 11.83% and 2.1% respectively. All (21) MRSA isolates were highly resistant to penicillin and erythromycin, and 17 (85.7%) were highly sensitive to vancomycin. Being male (AOR 6.74, 95% CI 1.31-34.76), history of sickness in past year (AOR 4.89, 95% CI 1.82- 13.12), being sick for more 3 times (AOR 8.91, 95% CI 2.32-34.20), being diabetic (AOR 4.87, 95% CI 1.55-15.36) and illicit drug use (AOR 10.18, 95%CI 1.36-76.52) were found to be independently associated with MRSA colonization. Conclusion A study identified a high prevalence of MRSA colonization among patients admitted in the ICU. MRSA isolates were highly resistant to penicillin and erythromycin. History of illegal drug use was highly associated with MRSA colonization.
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Affiliation(s)
- Alfred Geofrey
- Tanzania Field Epidemiology and Laboratory Training Program, Dar Es Salaam, Tanzania
| | - Ahmed Abade
- Tanzania Field Epidemiology and Laboratory Training Program, Dar Es Salaam, Tanzania
| | - Said Aboud
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar Es Salaam, Tanzania
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Youn SH, Lee SS, Kim S, Lee JA, Kim BJ, Kim J, Han HK, Kim JS. Drug utilization review of mupirocin ointment in a Korean university-affiliated hospital. Korean J Intern Med 2015; 30:515-20. [PMID: 26161018 PMCID: PMC4497339 DOI: 10.3904/kjim.2015.30.4.515] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 09/16/2014] [Accepted: 10/10/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Intranasal mupirocin and chlorhexidine bathing are candidate strategies to prevent healthcare-associated infections caused by methicillin-resistant Staphylococcus aureus (MRSA). In Korea, intranasal mupirocin is not available, and mupirocin ointment, an over-the-counter drug, has been used indiscriminately. Furthermore, because it is covered by health insurance, mupirocin is easy to prescribe within hospitals. METHODS We performed a mupirocin drug utilization review (DUR) within Hallym University Sacred Heart Hospital. Annual use of mupirocin was investigated between 2003 and 2013, and monthly consumption of mupirocin was assessed during the final 2-year period. The DUR focused on August 2012, the period of highest use of mupirocin. Also, we investigated trends in mupirocin resistance in MRSA between 2011 and 2013. RESULTS Annual consumption of mupirocin increased from 3,529 tubes in 2003 to 6,475 tubes in 2013. During August 2012, 817 tubes were prescribed to 598 patients; of these, 84.9% were prescribed to outpatients, and 77.6% at the dermatology department. The most common indication was prevention of skin infections (84.9%), and the ointment was combined with systemic antibiotics in 62.9% of cases. The average duration of systemic antibiotic administration was about 7.8 days. The rate of low-level mupirocin resistance in MRSA increased from 8.0% to 22.0%, and that of high-level mupirocin resistance increased from about 4.0% to about 7.5%. CONCLUSIONS Inappropriate use of mupirocin is prevalent. Considering the increase in resistance and the future application of intranasal mupirocin, prophylactic use of mupirocin in dermatology departments should be reconsidered.
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Affiliation(s)
- Sung Hee Youn
- Division of Infectious Diseases, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Seung Soon Lee
- Division of Infectious Diseases, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Sukyeon Kim
- Division of Infectious Diseases, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Jeong-a Lee
- Division of Infectious Diseases, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Bum Joon Kim
- Division of Infectious Diseases, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Jounghee Kim
- Department of Pharmacy, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Hye-kyung Han
- Department of Pharmacy, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Jae-Seok Kim
- Department of Laboratory Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
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Harris PNA, Le BD, Tambyah P, Hsu LY, Pada S, Archuleta S, Salmon S, Mukhopadhyay A, Dillon J, Ware R, Fisher DA. Antiseptic Body Washes for Reducing the Transmission of Methicillin-Resistant Staphylococcus aureus: A Cluster Crossover Study. Open Forum Infect Dis 2015; 2:ofv051. [PMID: 26125031 PMCID: PMC4462889 DOI: 10.1093/ofid/ofv051] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 04/14/2015] [Indexed: 12/16/2022] Open
Abstract
In a cluster cross-over trial, targeted decolonization with octenidine body washes was not associated with reduction in MRSA transmission or infection Background. Limiting the spread of methicillin-resistant Staphylococcus aureus (MRSA) within healthcare facilities where the organism is highly endemic is a challenge. The use of topical antiseptic agents may help interrupt the transmission of MRSA and reduce the risk of clinical infection. Octenidine dihydrochloride is a topical antiseptic that exhibits in vitro efficacy against a wide variety of bacteria, including S aureus. Methods. We conducted a prospective cluster crossover study to compare the use of daily octenidine body washes with soap and water in patients identified by active surveillance cultures to be MRSA-colonized, to prevent the acquisition of MRSA in patients with negative screening swabs. Five adult medical and surgical wards and 2 intensive care units were selected. The study involved an initial 6-month phase using octenidine or soap washes followed by a crossover in each ward to the alternative product. The primary and secondary outcomes were the rates of new MRSA acquisitions and MRSA clinical infections, respectively. Results. A total of 10 936 patients admitted for ≥48 hours was included in the analysis. There was a small reduction in MRSA acquisition in the intervention group compared with controls (3.0% vs 3.3%), but this reduction was not significant (odds ratio, 0.89; 95% confidence interval, .72–1.11; P = .31). There were also no significant differences in clinical MRSA infection or incidence of MRSA bacteremia. Conclusions. This study suggests that the targeted use of routine antiseptic washes may not in itself be adequate to reduce the transmission of MRSA in an endemic hospital setting.
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Affiliation(s)
- Patrick N A Harris
- Division of Infectious Diseases , University Medicine Cluster, National University Hospital ; Department of Medicine , Yong Loo Lin School of Medicine, National University of Singapore ; UQ Centre for Clinical Research , University of Queensland , Brisbane , Australia
| | - Bich Diep Le
- Division of Infectious Diseases , University Medicine Cluster, National University Hospital
| | - Paul Tambyah
- Division of Infectious Diseases , University Medicine Cluster, National University Hospital ; Department of Medicine , Yong Loo Lin School of Medicine, National University of Singapore
| | - Li Yang Hsu
- Division of Infectious Diseases , University Medicine Cluster, National University Hospital ; Department of Medicine , Yong Loo Lin School of Medicine, National University of Singapore
| | - Surinder Pada
- Division of Infectious Diseases , University Medicine Cluster, National University Hospital ; Department of Medicine , Yong Loo Lin School of Medicine, National University of Singapore ; Department of Medicine , Alexandra Hospital, Jurong Health Services
| | - Sophia Archuleta
- Division of Infectious Diseases , University Medicine Cluster, National University Hospital ; Department of Medicine , Yong Loo Lin School of Medicine, National University of Singapore
| | - Sharon Salmon
- Nursing Administration , National University Hospital , Singapore
| | - Amartya Mukhopadhyay
- Department of Medicine , Yong Loo Lin School of Medicine, National University of Singapore
| | - Jasmine Dillon
- School of Medicine , University of Queensland , St Lucia
| | - Robert Ware
- School of Population Health , University of Queensland , Brisbane , Australia
| | - Dale A Fisher
- Division of Infectious Diseases , University Medicine Cluster, National University Hospital ; Department of Medicine , Yong Loo Lin School of Medicine, National University of Singapore
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Lee YJ, Chen JZ, Lin HC, Liu HY, Lin SY, Lin HH, Fang CT, Hsueh PR. Impact of active screening for methicillin-resistant Staphylococcus aureus (MRSA) and decolonization on MRSA infections, mortality and medical cost: a quasi-experimental study in surgical intensive care unit. Crit Care 2015; 19:143. [PMID: 25882709 PMCID: PMC4403941 DOI: 10.1186/s13054-015-0876-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 03/11/2015] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Methicillin-resistant Staphylococcus aureus (MRSA) is a leading pathogen of healthcare-associated infections in intensive care units (ICUs). Prior studies have shown that decolonization of MRSA carriers is an effective method to reduce MRSA infections in ICU patients. However, there is currently a lack of data on its effect on mortality and medical cost. METHODS Using a quasi-experimental, interrupted time-series design with re-introduction of intervention, we evaluated the impact of active screening and decolonization on MRSA infections, mortality and medical costs in the surgical ICU of a university hospital in Taiwan. Regression models were used to adjust for effects of confounding variables. RESULTS MRSA infection rate decreased from 3.58 (baseline) to 0.42‰ (intervention period) (P <0.05), re-surged to 2.21‰ (interruption period) and decreased to 0.18‰ (re-introduction of intervention period) (P <0.05). Patients admitted to the surgical ICU during the intervention periods had a lower in-hospital mortality (13.5% (155 out of 1,147) versus 16.6% (203 out of 1,226), P = 0.038). After adjusting for effects of confounding variables, the active screening and decolonization program was independently associated with a decrease in in-hospital MRSA infections (adjusted odds ratio: 0.3; 95% CI: 0.1 to 0.8) and 90-day mortality (adjusted hazard ratio: 0.8; 95% CI: 0.7 to 0.99). Cost analysis showed that $22 medical costs can be saved for every $1 spent on the intervention. CONCLUSIONS Active screening for MRSA and decolonization in ICU settings is associated with a decrease in MRSA infections, mortality and medical cost.
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Affiliation(s)
- Yuarn-Jang Lee
- Division of Infectious Diseases, Department of Internal Medicine, Taipei Medical University Hospital, 252 Wusing Street, Taipei, 11031, Taiwan. .,Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, 250 Wusing Street, Taipei, 11031, Taiwan.
| | - Jen-Zon Chen
- Department of Infection Control, Taipei Medical University Hospital, 252 Wusing Street, Taipei, 11031, Taiwan.
| | - Hsiu-Chen Lin
- Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, 250 Wusing Street, Taipei, 11031, Taiwan. .,Department of Laboratory Medicine, Taipei Medical University Hospital, 252 Wusing Street, Taipei, 11031, Taiwan.
| | - Hsin-Yi Liu
- Division of Infectious Diseases, Department of Internal Medicine, Taipei Medical University Hospital, 252 Wusing Street, Taipei, 11031, Taiwan.
| | - Shyr-Yi Lin
- Department of General Medicine, School of Medicine, College of Medicine, Taipei Medical University, 250 Wusing Street, Taipei, 11031, Taiwan.
| | - Hsien-Ho Lin
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, 17 Xu-Zhou Road, Taipei, 10002, Taiwan.
| | - Chi-Tai Fang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, 17 Xu-Zhou Road, Taipei, 10002, Taiwan. .,Department of Internal Medicine, National Taiwan University Hospital, 7 Chun-Shan South Road, Taipei, 10002, Taiwan.
| | - Po-Ren Hsueh
- Department of Internal Medicine, National Taiwan University Hospital, 7 Chun-Shan South Road, Taipei, 10002, Taiwan. .,Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, 1 Jen-Ai Road, Taipei, 10055, Taiwan.
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Calfee DP, Salgado CD, Milstone AM, Harris AD, Kuhar DT, Moody J, Aureden K, Huang SS, Maragakis LL, Yokoe DS. Strategies to prevent methicillin-resistant Staphylococcus aureus transmission and infection in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2015; 35:772-96. [PMID: 24915205 DOI: 10.1086/676534] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Calderwood MS. Editorial Commentary: Duration of Colonization With Methicillin-Resistant Staphylococcus aureus: A Question With Many Answers. Clin Infect Dis 2015; 60:1497-9. [PMID: 25648241 PMCID: PMC4412190 DOI: 10.1093/cid/civ082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 01/27/2015] [Indexed: 12/05/2022] Open
Affiliation(s)
- Michael S Calderwood
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts
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Robicsek A, Beaumont JL, Thomson RB, Govindarajan G, Peterson LR. Topical Therapy for Methicillin-Resistant Staphylococcus aureus Colonization Impact on Infection Risk. Infect Control Hosp Epidemiol 2015; 30:623-32. [DOI: 10.1086/597550] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective.We evaluated the usefulness of topical decolonization therapy for reducing the risk of methicillin-resistant Staphylococcus aureus (MRSA) infection among MRSA-colonized inpatients.Design.Retrospective cohort study.Setting and Intervention.Three hospitals with universal surveillance for MRSA; at their physician's discretion, colonized patients could be treated with a 5-day course of nasal mupirocin calcium 2%, twice daily, plus Chlorhexidine gluconate 4% every second day.Patients and Methods.MRSA carriers were later retested for colonization (407 subjects; study 1) or followed up for development of MRSA infection (933 subjects; study 2). Multivariable methods were used to determine the impact of decolonization therapy on the risks of sustained colonization (in study 1) and MRSA infection (in study 2).Results.Independent risk factors for sustained colonization included residence in a long-term care facility (odds ratio [OR], 1.8 [95% confidence interval {CI}, 1.1–3.2]) and a pressure ulcer (OR, 2.3 195% CI, 1.2–4.4]). Mupirocin at any dose decreased this risk, particularly during the 30-60-day period after therapy; mupirocin resistance increased this risk (OR, 4.1 [95% CI, 1.6–10.7]). Over a median follow-up duration of 269 days, 69 (7.4%) of 933 patients developed infection. Independent risk factors for infection were length of stay (hazard ratio [HR], 1.2 per 5 additional days [95% CI, 1.0–1.4]), chronic lung disease (HR, 1.7 [95% CI, 1.0–2.8]), and receipt of non-MRSA-active systemic antimicrobial agents (HR, 1.8 [95% CI, 1.1–3.1]). Receipt of mupirocin did not affect the risk of infection, although there was a trend toward delayed infection among patients receiving mupirocin (median time to infection, 50 vs 15.5 days; P = .06).Conclusions.Mupirocin-based decolonization therapy temporarily reduced the risk of continued colonization but did not decrease the risk of subsequent infection.
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Calfee DP, Salgado CD, Classen D, Arias KM, Podgorny K, Anderson DJ, Burstin H, Coffin SE, Dubberke ER, Fraser V, Gerding DN, Griffin FA, Gross P, Kaye KS, Klompas M, Lo E, Marschall J, Mermel LA, Nicolle L, Pegues DA, Perl TM, Saint S, Weinstein RA, Wise R, Yokoe DS. Strategies to Prevent Transmission of Methicillin-ResistantStaphylococcus aureusin Acute Care Hospitals. Infect Control Hosp Epidemiol 2015; 29 Suppl 1:S62-80. [DOI: 10.1086/591061] [Citation(s) in RCA: 152] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). Our intent in this document is to highlight practical recommendations in a concise format to assist acute care hospitals in their efforts to prevent transmission of methicillin-resistantStaphylococcus aureus(MRSA). Refer to the Society for Healthcare Epidemiology of America/Infectious Diseases Society of America “Compendium of Strategies to Prevent Healthcare-Associated Infections” Executive Summary, Introduction, and accompanying editorial for additional discussion.1. Burden of HAIs caused by MRSA in acute care facilitiesa. In the United States, the proportion of hospital-associatedS. aureusinfections that are caused by strains resistant to methicillin has steadily increased. In 2004, MRSA accounted for 63% ofS. aureusinfections in hospitals.b. Although the proportion ofS. aureus–associated HAIs among intensive care unit (ICU) patients that are due to methicillin-resistant strains has increased (a relative measure of the MRSA problem), recent data suggest that the incidence of central line–associated bloodstream infection caused by MRSA (an absolute measure of the problem) has decreased in several types of ICUs since 2001. Although these findings suggest that there has been some success in preventing nosocomial MRSA transmission and infection, many patient groups continue to be at risk for such transmission.c. MRSA has also been documented in other areas of the hospital and in other types of healthcare facilities, including those that provide long-term care.
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Whitman TJ, Herlihy RK, Schlett CD, Murray PR, Grandits GA, Ganesan A, Brown M, Mancuso JD, Adams WB, Tribble DR. Chlorhexidine-Impregnated Cloths to Prevent Skin and Soft-Tissue Infection in Marine Recruits: A Cluster-Randomized, Double-Blind, Controlled Effectiveness Trial. Infect Control Hosp Epidemiol 2015; 31:1207-15. [DOI: 10.1086/657136] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background.Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) causes skin and soft-tissue infection (SSTI) in military recruits.Objective.To evaluate the effectiveness of 2% Chlorhexidine gluconate (CHG)-impregnated cloths in reducing rates of SSTI and S. aureus colonization among military recruits.Design.A cluster-randomized (by platoon), double-blind, controlled effectiveness trial.Setting.Marine Officer Candidate School, Quantico, Virginia, 2007.Participants.Military recruits.Intervention.Application of CHG-impregnated or control (Comfort Bath; Sage) cloths applied over entire body thrice weekly.Measurements.Recruits were monitored daily for SSTI. Baseline and serial nasal and/or axillary swabs were collected to assess S. aureus colonization.Results.Of 1,562 subjects enrolled, 781 (from 23 platoons) underwent CHG-impregnated cloth application and 781 (from 21 platoons) underwent control cloth application. The rate of compliance (defined as application of 50% or more of wipes) at 2 weeks was similar (CHG group, 63%; control group, 67%) and decreased over the 6-week period. The mean 6-week SSTI rate in the CHG-impregnated cloth group was 0.094, compared with 0.071 in the control group (analysis of variance model rate difference, 0.025 ± 0.016; P = .14). At baseline, 43% of subjects were colonized with methicillin-susceptible S. aureus (MSSA), and 2.1% were colonized with MRSA. The mean incidence of colonization with MSSA was 50% and 61% (P = .026) and with MRSA was 2.6% and 6.0% (P = .034) for the CHG-impregnated and control cloth groups, respectively.Conclusions.CHG-impregnated cloths applied thrice weekly did not reduce rates of SSTI among recruits. S. aureus colonization rates increased in both groups but to a lesser extent in those assigned to the CHG-impregnated cloth Intervention. Antecedent S. aureus colonization was not a risk factor for SSTI. Additional studies are needed to identify effective measures for preventing SSTI among military recruits.Clinical Trials Registration.ClinicalTrials.gov identifier: NCT00475930.
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Rising Methicillin-Resistant Staphylococcus aureus Infections in Ear, Nose, and Throat Diseases. Case Rep Otolaryngol 2014; 2014:253945. [PMID: 25431718 PMCID: PMC4241322 DOI: 10.1155/2014/253945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 10/20/2014] [Indexed: 12/03/2022] Open
Abstract
The increasing incidence of methicillin-resistant Staphylococcus aureus infections (MRSA) in ENT diseases is becoming a big clinical concern. Here two patients are described who developed MRSA infections presented with unusual post-FESS epistaxis and postmastoidectomy perichondrial abscess and failed treatment with broad spectrum intravenous antibiotics. Following treatment with oral linezolid combined with local mupirocin dressing both patients fully recovered.
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Decolonization to prevent Staphylococcus aureus transmission and infections in the neonatal intensive care unit. J Perinatol 2014; 34:805-10. [PMID: 25010222 DOI: 10.1038/jp.2014.128] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 03/26/2014] [Accepted: 05/05/2014] [Indexed: 01/03/2023]
Abstract
Staphylococcus aureus (S. aureus) continues to be a leading cause of outbreaks and health-care-associated infections in neonatal intensive care units. In the first few months of life, many neonates acquire S. aureus as part of their delicate and evolving microbiota. Neonates that asymptomatically acquire S. aureus colonization are at increased risk of developing a subsequent S. aureus infection. This review discusses the epidemiology and prevention of S. aureus disease in neonates and how decolonization to eradicate S. aureus may decrease S. aureus transmission and infections in the neonatal intensive care unit.
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Abstract
Although originally described in Staphylococcus aureus, resistance among bacteria has now become a race to determine which classes of bacteria will become more resistant. Availability of antibacterial agents has allowed the development of entirely new diseases caused by nonbacterial pathogens, related largely to fungi that are inherently resistant to antibacterials. This article presents the growing body of knowledge of the herpes family of viruses, and their occurrence and consequences in patients with concomitant surgical disease or critical illness. The focus is on previously immunocompetent patients, as the impact of herpes viruses in immunosuppressed patients has received thorough coverage elsewhere.
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Affiliation(s)
- Christopher A Guidry
- Division of Acute Care Surgery and Outcomes Research, Department of Surgery, University of Virginia, Charlottesville, VA 22908, USA
| | - Sara A Mansfield
- Division of Trauma, Critical Care, and Burn, Department of Surgery, The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Robert G Sawyer
- Division of Acute Care Surgery and Outcomes Research, Department of Surgery, University of Virginia, Charlottesville, VA 22908, USA
| | - Charles H Cook
- Division of Acute Care Surgery, Trauma and Surgical Critical Care, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Lowry 2G, Boston, MA 02215, USA.
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Huang SS, Septimus E, Avery TR, Lee GM, Hickok J, Weinstein RA, Moody J, Hayden MK, Perlin JB, Platt R, Ray GT. Cost savings of universal decolonization to prevent intensive care unit infection: implications of the REDUCE MRSA trial. Infect Control Hosp Epidemiol 2014; 35 Suppl 3:S23-31. [PMID: 25222894 PMCID: PMC10920056 DOI: 10.1086/677819] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To estimate and compare the impact on healthcare costs of 3 alternative strategies for reducing bloodstream infections in the intensive care unit (ICU): methicillin-resistant Staphylococcus aureus (MRSA) nares screening and isolation, targeted decolonization (ie, screening, isolation, and decolonization of MRSA carriers or infections), and universal decolonization (ie, no screening and decolonization of all ICU patients). DESIGN Cost analysis using decision modeling. METHODS We developed a decision-analysis model to estimate the health care costs of targeted decolonization and universal decolonization strategies compared with a strategy of MRSA nares screening and isolation. Effectiveness estimates were derived from a recent randomized trial of the 3 strategies, and cost estimates were derived from the literature. RESULTS In the base case, universal decolonization was the dominant strategy and was estimated to have both lower intervention costs and lower total ICU costs than either screening and isolation or targeted decolonization. Compared with screening and isolation, universal decolonization was estimated to save $171,000 and prevent 9 additional bloodstream infections for every 1,000 ICU admissions. The dominance of universal decolonization persisted under a wide range of cost and effectiveness assumptions. CONCLUSIONS A strategy of universal decolonization for patients admitted to the ICU would both reduce bloodstream infections and likely reduce healthcare costs compared with strategies of MRSA nares screening and isolation or screening and isolation coupled with targeted decolonization.
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Affiliation(s)
- Susan S Huang
- Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Orange, California
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Kock R, Becker K, Cookson B, van Gemert-Pijnen JE, Harbarth S, Kluytmans J, Mielke M, Peters G, Skov RL, Struelens MJ, Tacconelli E, Witte W, Friedrich AW. Systematic literature analysis and review of targeted preventive measures to limit healthcare-associated infections by meticillin-resistant Staphylococcus aureus. ACTA ACUST UNITED AC 2014; 19. [PMID: 25080142 DOI: 10.2807/1560-7917.es2014.19.29.20860] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Meticillin-resistant Staphylococcus aureus (MRSA) is a major cause of healthcare-associated infections in Europe. Many examples have demonstrated that the spread of MRSA within healthcare settings can be reduced by targeted infection control measures. The aim of this systematic literature analysis and review was to summarise the evidence for the use of bacterial cultures for active surveillance the benefit of rapid screening tests, as well as the use of decolonisation therapies and different types of isolation measures. We included 83 studies published between 2000 and 2012. Although the studies reported good evidence supporting the role of active surveillance followed by decolonisation therapy, the effectiveness of single-room isolation was mostly shown in non-controlled studies, which should inspire further research regarding this issue. Overall, this review highlighted that when planning the implementation of preventive interventions, there is a need to consider the prevalence of MRSA, the incidence of infections, the competing effect of standard control measures (e.g. hand hygiene) and the likelihood of transmission in the respective settings of implementation.
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Affiliation(s)
- R Kock
- Institute of Hygiene, University Hospital Munster, Munster, Germany
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