A computer simulation model of the cost-effectiveness of routine Staphylococcus aureus screening and decolonization among lung and heart-lung transplant recipients

Clancy, Cornelius J.; Bartsch, Sarah M.; Stuckey, Dianna R.; Shields, Ryan K.; Lee, B. Y.

doi:10.1007/s10096-013-2046-y

Cited by 19 publications

(6 citation statements)

References 34 publications

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“…However, this model was based on data from a hospital in Geneva, which may have lower rates of MRSA colonization than U.S. hospitals. Conversely, using data inputs from the United States, multiple studies found that MRSA screening and decolonization prior to cardiac, vascular, or orthopedic surgery or heartlung transplant was cost-effective from the third-party payer perspective and the hospital perspective (50,(157)(158)(159)(160)(161). However, Lee et al, found that screening and decolonization of pregnant women prior to cesarean delivery were not cost-effective (162).…”

Section: Economic Viabilitymentioning

confidence: 99%

Decolonization in Prevention of Health Care-Associated Infections

2016

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SUMMARYColonization with health care-associated pathogens such asStaphylococcus aureus, enterococci, Gram-negative organisms, andClostridium difficileis 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 onS. aureusdecolonization, 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 forS. aureusnasal 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 asCandida. 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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Section: Economic Viabilitymentioning

confidence: 99%

Decolonization in Prevention of Health Care-Associated Infections

2016

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“…Modeling using data on LTRs with respect to the incidence of MRSA colonization post-LT, the risk of subsequent Staph. aureus infection, and estimates on the efficacy of decolonization with mupirocin and chlorhexidine suggested active surveillance for MRSA colonization and decolonization could reduce infections and save costs (202). Results of clinical trials in other SOTs have been conflicting.…”

Section: Peri-transplant Prophylaxismentioning

confidence: 99%

Bacterial infections in lung transplantation

McCort¹,

MacKenzie²,

Pursell³

et al. 2021

J Thorac Dis

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Lung transplantation has lower survival rates compared to other than other solid organ transplants (SOT) due to higher rates of infection and rejection-related complications, and bacterial infections (BI) are the most frequent infectious complications. Excess morbidity and mortality are not only a direct consequence of these BI, but so are subsequent loss of allograft tolerance, rejection, and chronic lung allograft dysfunction due to bronchiolitis obliterans syndrome (BOS). A wide variety of pathogens can cause infections in lung transplant recipients (LTRs), including a number of nosocomial pathogens and other multidrug-resistant (MDR) pathogens. Although pneumonia and intrathoracic infections predominate, LTRs are at risk of a number of types of infections. Risk factors include altered anatomy and function of airways, impaired immunity, the microbial flora of the donor and recipient, underlying medical conditions, and genetic factors. Further work on immune monitoring has the potential to improve outcomes. The infecting agents can be derived from the donor lung, pre-existing recipient flora, or acquired from the environment over time. Certain infections may preclude lung transplantation, but this varies from center to center, and more recent studies suggest fewer patients should be disqualified. New molecular methods allow microbiome studies of the lung, gut, and other sites that may further our knowledge of how airway colonization can result in infection and allograft loss. Surveillance, early diagnosis, and aggressive antimicrobial therapy of BI is critical in LTRs. Antibiotic resistance is a major barrier to successful management of these infections. The availability of new agents for MDR Gram-negatives may improve outcomes. Other new therapies, such as bacteriophage therapy, show promise for the future. Finally, it is important to prevent infections through peri-transplant prophylaxis, vaccination, and infection control measures.

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“…In light of the high prevalence of MRSA infections among lung transplant recipients, vancomycin is often used for perioperative prophylaxis (24). A computer simulation model study suggested that screening and decolonization of MRSA among lung transplant recipients would be cost-effective (25). However, further research is needed before active surveillance can be recommended (24).…”

Section: Staphylococcus Aureusmentioning

confidence: 99%

Management and prophylaxis of bacterial and mycobacterial infections among lung transplant recipients

Okamoto¹,

Santos²

2020

Ann Transl Med

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Bacterial and mycobacterial infections are associated with morbidity and mortality in lung transplant recipients. Infectious complications are categorized by timing post-transplant: <1, 1-6, and >6 months. The first month post-transplant is associated with the highest risk of infection. During this period, infections are most commonly healthcare-associated, and include infections related to surgical complications. The lungs and bloodstream are common sites of infections. Common healthcare-associated organisms include methicillin-resistant Staphylococcus aureus (MRSA), Gram-negative bacilli such as Pseudomonas aeruginosa, and Clostridioides difficile. More than 1-month post-transplant, opportunistic infections can occur. Tuberculosis occurs in 0.8-10% of lung transplant recipients which reflects variation in background prevalence. The majority of post-transplant tuberculosis stems from reactivation of untreated or undiagnosed latent tuberculosis. Most post-transplant tuberculosis occurs in the lungs and develops within a year of transplant. Non-tuberculous mycobacteria commonly colonize the lungs of lung transplantcandidates and are often hard to eradicate even with prolonged courses of antimycobacterial agents. Drug interactions between antimycobacterial agents and calcineurin and mTOR inhibitors also complicates treatment post-transplant. Given that infection adversely impacts outcomes after lung transplant, and that anti-infective therapy is often less effective after transplant, infection prevention is key to long-term success. A comprehensive approach that includes pre-transplant evaluation, perioperative prophylaxis, longterm antimicrobial prophylaxis, immunization, and safer living at home and in the community, should be employed to minimize the risk of infection.

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A computer simulation model of the cost-effectiveness of routine Staphylococcus aureus screening and decolonization among lung and heart-lung transplant recipients

Cited by 19 publications

References 34 publications

Decolonization in Prevention of Health Care-Associated Infections

Decolonization in Prevention of Health Care-Associated Infections

Bacterial infections in lung transplantation

Management and prophylaxis of bacterial and mycobacterial infections among lung transplant recipients

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