Enteral vancomycin to control methicillin-resistant Staphylococcus aureus outbreak in mechanically ventilated patients

Silvestri, Luciano; Milanese, Marco; Oblach, Luisa; Fontana, Francesco; Gregori, Darío; Guerra, R.; Saene, H. K. F. van

doi:10.1067/mic.2002.122255

Cited by 86 publications

(61 citation statements)

References 43 publications

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“…Vancomycin is inactivated by faecal material, necrotic cells and fibres along its passage through the alimentary canal. The absence of VRE and VISA is in line with a recent situation during which intestinal vancomycin was administered to control an MRSA outbreak [32].…”

Section: Discussionsupporting

confidence: 60%

Prevention of MRSA pneumonia by oral vancomycin decontamination: a randomised trial

Silvestri

Saene²,

Milanese³

et al. 2004

Eur Respir J

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This study was undertaken to assess whether oropharyngeal vancomycin may control oropharyngeal carriage and lower airway infection due to methicillinresistant Staphylococcus aureus (MRSA) acquired in the intensive care unit (ICU). Secondary endpoints were the emergence of vancomycin-resistant enterococci, vancomycin-intermediate S. aureus and vancomycin consumption.A total of 84 patients, admitted to a medical/surgical ICU and mechanically ventilated for w72 h, were randomly assigned to control (n=42) or test (n=42) group. Both groups received the protocol of selective decontamination of the digestive tract, including polymyxin E, tobramycin and amphotericin B. Patients in the test group received 0.5 g of a 4% vancomycin gel at 6-h intervals in the oropharynx.Lower Aspiration of contaminated oropharyngeal secretions is the main pathway for the development of lower airway infections in patients requiring mechanical ventilation on the intensive care unit (ICU) [1]. Individuals with an underlying disease are often oropharyngeal carriers of abnormal aerobic Gramnegative bacilli (AGNB) [2] and methicillin-resistant Staphylococcus aureus (MRSA) [3]. Prevention and eradication of the abnormal carrier state can be achieved by the administration of nonabsorbable antimicrobials into the oropharynx, as part of selective decontamination of the digestive tract (SDD) [4].The European Task Force on ventilator-associated pneumonia [5] and the Consensus Conference in Critical Care on ICU-acquired pneumonia [6] acknowledged SDD as an evidence-based manoeuvre that reduces both pneumonia and mortality. These recommendations were based on two metaanalyses of randomised controlled trials [7,8]. Recently, two individual trials of huge sample size confirmed the metaanalytic evidence [9,10]. The SDD strategy, using both parenteral and enteral antibiotics, significantly reduced pneumonia and other lower airway infections, combined with 8% absolute mortality reduction. The impact of SDD was similar in medical and surgical patients. Surveillance cultures are recommended to detect emergence of resistance.Three SDD trials included oropharyngeal vancomycin in order to clear MRSA, which is intrinsically resistant to polymyxin and aminoglycosides, from the oropharyngeal cavity [11][12][13]. However, a separate analysis of the impact of topical vancomycin on MRSA lower airway infections was not performed in any of these studies.A randomised trial was conducted to assess the impact of a 4% vancomycin gel, applied into the oropharynx, on MRSA lower airway infections in patients treated on a medical/ surgical ICU. Secondary endpoints were carriage rates and indices of MRSA in the oropharynx, the emergence of vancomycin-resistant enterococci (VRE), as well as vancomycinintermediate S. aureus (VISA) and vancomycin consumption. Material and methods Study subjectsThis study was conducted over a 1-yr period, in an eightbedded ICU, at a multidisciplinary regional-referral hospital. The ICU is a facility with an annual admission rate of y350 pat...

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Section: Discussionsupporting

confidence: 60%

Prevention of MRSA pneumonia by oral vancomycin decontamination: a randomised trial

Silvestri

Saene²,

Milanese³

et al. 2004

Eur Respir J

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“…The enteral antimicrobials polymyxin, tobramycin and vancomycin effectively eradicated imported, and successfully prevented acquisition and de novo development of resistance [23,[25][26][27][28]. The proposed mechanism to explain the demonstrated efficacy of SDD to control the acquisition of antibiotic resistance is that faecal concentrations of enteral antimicrobials are usually high enough to exceed the minimal bactericidal concentration of ARB.…”

Section: Discussionmentioning

confidence: 99%

Long-term use of selective decontamination of the digestive tract does not increase antibiotic resistance: a 5-year prospective cohort study

et al. 2011

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“…However, treatment is not targeted at gastrointestinal colonization, facilitating recolonization of other body sites. Silvestri et al 29 found eradication of MRSA gut carriage by treatment with enteral vancomycin to be effective in the reduction of the rate of MRSA colonization and infection in an outbreak among patients receiving mechanical ventilation in intensive care units. Maraha et al 26 reported a 100% success rate for MRSA decolonization with enteral vancomycin and topical antimicrobial treatment during an outbreak in a urological unit.…”

Section: Discussionmentioning

confidence: 99%

Highly Effective Regimen for Decolonization of Methicillin-ResistantStaphylococcus aureusCarriers

Buehlmann

Frei

Fenner

et al. 2008

Infect. Control Hosp. Epidemiol.

131

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OBJECTIVE. To evaluate the efficacy of a standardized regimen for decolonization of methicillin-resistant Staphylococcus aureus (MRSA) carriers and to identify factors influencing decolonization treatment failure. SETTING. University hospital with 750 beds and 27,000 admissions/year. PATIENTS. Of 94 consecutive hospitalized patients with MRSA colonization or infection, 32 were excluded because of spontaneous loss of MRSA, contraindications, death, or refusal to participate. In 62 patients, decolonization treatment was completed. At least 6 body sites were screened for MRSA (including by use of rectal swabs) before the start of treatment.INTERVENTIONS. Standardized decolonization treatment consisted of mupirocin nasal ointment, chlorhexidine mouth rinse, and full-body wash with chlorhexidine soap for 5 days. Intestinal and urinary-tract colonization were treated with oral vancomycin and cotrimoxazole, respectively. Vaginal colonization was treated with povidone-iodine or, alternatively, with chlorhexidine ovula or octenidine solution. Other antibiotics were added to the regimen if treatment failed. Successful decolonization was considered to have been achieved if results were negative for 3 consecutive sets of cultures of more than 6 screening sites. ). Decolonization was completed in 87% of patients after a mean (±SD) of 2.1 ± 1.8 decolonization cycles (range, 1-10 cycles). Sixty-five percent of patients ultimately required peroral antibiotic treatment (vancomycin, 52%; cotrimoxazole, 27%; rifampin and fusidic acid, 18%). Decolonization was successful in 54 (87%) of the patients in the intent-to-treat analysis and in 51 (98%) of 52 patients in the on-treatment analysis.CONCLUSION. This standardized regimen for MRSA decolonization was highly effective in patients who completed the full decolonization treatment course. 2008; 29:510-516 In past decades, methicillin-resistant Staphylococcus aureus and outbreaks among injection drug abusers, prisoners, homeless (MRSA) has become the most important multidrug-resistant individuals, sports teams, and children in day care centers. 5,6 pathogen worldwide, causing significant morbidity and increased Studies of surgical patients colonized with methicillinhealthcare costs. Infect Control Hosp Epidemiol1,2 MRSA colonization precedes MRSA infection, susceptible S. aureus have demonstrated that decolonization which occurs in 20%-60% of colonized patients in acute-care treatment-for example, with mupirocin-can reduce the infacilities and in 3%-15% of those in long-term-care facilities. 3 The cidence of subsequent infection. 7 In addition, most authorities rate of nosocomial transmission of MRSA in healthcare facilities recommend that MRSA carriers be decolonized in outbreak can be reduced by the use of strict infection-control measures, situations. such as establishment of MRSA surveillance; early identification MRSA decolonization may reduce the risk of MRSA infecof carriers; isolation of colonized or infected patients; use of bartion in individual carriers and could prevent...

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Enteral vancomycin to control methicillin-resistant Staphylococcus aureus outbreak in mechanically ventilated patients

Cited by 86 publications

References 43 publications

Prevention of MRSA pneumonia by oral vancomycin decontamination: a randomised trial

Prevention of MRSA pneumonia by oral vancomycin decontamination: a randomised trial

Long-term use of selective decontamination of the digestive tract does not increase antibiotic resistance: a 5-year prospective cohort study

Highly Effective Regimen for Decolonization of Methicillin-ResistantStaphylococcus aureusCarriers

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