Effect of antibiotics on the bacterial load of meticillin-resistant Staphylococcus aureus colonisation in anterior nares

Cheng, Vincent Chi-Chung; Li, I.W.S.; Wu, Alan Ka-Lun; Tang, Bone Siu-Fai; Ng, Kenneth H. L.; To, Kelvin Kai-Wang; Tse, Herman; Que, Tak-Lun; Ho, Pak-Leung; Yuen, Kwok‐Yung

doi:10.1016/j.jhin.2008.05.019

Cited by 55 publications

(48 citation statements)

References 18 publications

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“…Persistent S. aureus carriers have been found to carry a greater quantity of S. aureus in their noses (measured in log 10 CFU per nares culture) than intermittent carriers (46). Average S. aureus bacterial loads among nasal carriers tend to range between 1.8 and 2.9 log 10 CFU per nares culture (47,48). One study found that this load increased among MRSA carriers when patients received antibiotics that did not have activity against MRSA (e.g., beta-lactams or fluoroquinolones) (48).…”

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“…Average S. aureus bacterial loads among nasal carriers tend to range between 1.8 and 2.9 log 10 CFU per nares culture (47,48). One study found that this load increased among MRSA carriers when patients received antibiotics that did not have activity against MRSA (e.g., beta-lactams or fluoroquinolones) (48). They hypothesized that this may be due to either suppression of normal flora such as CNS, leading to overgrowth of MRSA, or an increase in the expression of MRSA adherence factors that promote colonization (48).…”

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confidence: 99%

“…One study found that this load increased among MRSA carriers when patients received antibiotics that did not have activity against MRSA (e.g., beta-lactams or fluoroquinolones) (48). They hypothesized that this may be due to either suppression of normal flora such as CNS, leading to overgrowth of MRSA, or an increase in the expression of MRSA adherence factors that promote colonization (48). Another study found that higher log counts of MRSA in the nose were associated with an increased likelihood of colonization at other body sites and a greater likelihood of high log counts at those body sites (49).…”

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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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Decolonization in Prevention of Health Care-Associated Infections

2016

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“…Increased numbers of ORSA were demonstrated in the noses of carriers receiving fluoroquinolones or β-lactams compared with controls 13 . Presumably this is due to a competitive advantage achieved by antibiotic administration, ablating the normal protective commensal flora, including oxacillinsensitive S. aureus (OSSA), allowing multiplication of the ORSA with increased potential for contaminating the environment 10 .…”

Section: Article/artigomentioning

confidence: 91%

Relationship between antibiotic consumption, oropharyngeal colonization, and ventilator-associated pneumonia by Staphylococcus aureus in an intensive care unit of a Brazilian teaching hospital

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Filho

2012

Rev. Soc. Bras. Med. Trop.

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INTRODUCTION: his study evaluated the consumption of major classes of antibiotics, the colonization of the oropharynx of patients on mechanical ventilation, and the risk of ventilator-associated pneumonia (VAP) caused by Staphylococcus aureus in an intensive care unit for adults. METHODS: A case-control study was carried out using colonized patients (cases) by oxacillin-resistant S. aureus (ORSA) and (controls) oxacillin-sensitive S. aureus (OSSA) from May 2009 to August 2010. The occurrence of VAP by S. aureus was also evaluated in the same period. Antibiotic consumption was expressed as the number of defined daily doses (DDD)/1,000 patient-days for glycopeptides, carbapenems, and extended-spectrum cephalosporins. RESULTS: Three hundred forty-six (56.1%) patients underwent mechanical ventilation with a frequency of oropharyngeal colonization of 36.4%, corresponding to 63.5% for ORSA and 36.5% for OSSA. The risk of illness for this organism was significant (p<0.05), regardless of whether colonization/infection was by ORSA or OSSA. The consumption of antibiotics was high, mainly for broad-spectrum cephalosporins (551.26 DDDs/1,000 patient-days). The high density of use of glycopeptides (269.56 DDDs/1,000 patient-days) was related to colonization by ORSA (Pearson r=0.57/p=0.02). Additionally, age >60 years, previous antibiotic therapy, and previous use of carbapenems were statistically significant by multivariate analysis. CONCLUSIONS: There was a significant relationship between the colonization of the oropharyngeal mucosa and the risk of VAP by both phenotypes. The use of glycopeptides was related to colonization by ORSA.

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“…The study found a 13% incidence of infection by the same strain of MRSA among colonized patients (Moore C et al, 2008). Another study that evaluated the prevalence of MRSA on admission identified that 49% of patients would not have been identified without screening on admission (VCC Cheng et al, 2008). In Europe and the United States the increase in infections caused by VRE in patients with ESKD have contributed to an increased morbidity and mortality in this patients population, which has generated a great concern in the nephrology services (Perencevich EM et al, 2004).…”

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