Epidemiology of Methicillin-Resistant <i>Staphylococcus aureus</i> Carriage and MRSA Surgical Site Infections in Patients Undergoing Colorectal Surgery: A Cohort Study in Two Centers

Huttner, Benedikt; Robicsek, Ari; Gervaz, Pascal; Perencevich, Eli N.; Schiffer, Eduardo; Schrenzel, Jacques; Harbarth, Stéphan Juergen

doi:10.1089/sur.2011.107

Cited by 16 publications

(13 citation statements)

References 20 publications

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“…Antimicrobial‐resistant bacterial infection and colonization, especially after surgery, is a major global clinical problem that is expected to continue to increase in parallel with the increase in the elderly population. The AMR bacterial infection rates in the present survey were lower than those previously reported . VRE or MDR‐GN was not isolated from any of the patients who participated in the present survey.…”

Section: Discussioncontrasting

confidence: 80%

“…Although a US survey conducted from 1999 to 2003 reported an incidence of CD colitis of 0.52%, recent evidence suggests an increase in this rate . Conversely, MRSA infections were reported in 0.9% of patients after colorectal surgery, whereas the frequency of ESBL was significantly increased among the community‐acquired infections . A UK surveillance study reported that the rate of ESBL was significantly increased from 11.5% in 2007 to 15.4% in 2012 and the rates of ESBL in RTI and UTI were significantly increased from 11.9% to 14.7% and from 9.4% to 16.6%, respectively, among patients receiving intensive care .…”

Section: Discussionmentioning

confidence: 99%

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Current status of postoperative infections after digestive surgery in Japan: The Japan Postoperative Infectious Complications Survey in 2015

Niitsuma

Kusachi

Takesue

et al. 2019

Annals of Gastroent Surgery

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Aim To survey postoperative infections (PI) after digestive surgery. Methods This survey, conducted by the Japan Society of Surgical Infection, included patients undergoing digestive surgery at 28 centers between September 2015 and March 2016. Data collected included patient background characteristics, type of surgery, contamination status, and type of PI, including surgical site infection (SSI), remote infection (RI), and antimicrobial‐resistant (AMR) bacterial infections and colonization. Results Postoperative infections occurred in 10.7% of 6582 patients who underwent digestive surgery (6.8% for endoscopic surgery and 18.7% for open surgery). SSI and RI, including respiratory tract infection, urinary tract infection, antibiotic‐associated diarrhea, drain infection, and catheter‐related bloodstream infection, occurred in 8.9% and 3.7% of patients, respectively. Among all PI, 13.2% were overlapping infections. The most common overlapping infections were incisional and organ/space SSI, which occurred in 4.2% of patients. AMR bacterial infections occurred in 1.2% of patients after digestive surgery and comprised 11.5% of all PI. Rate of AMR bacterial colonization after digestive surgery was only 0.3%. Conclusion Periodic surveillance of PI, including AMR bacteria, is necessary for a detailed evaluation of nosocomial infections.

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Section: Discussioncontrasting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Current status of postoperative infections after digestive surgery in Japan: The Japan Postoperative Infectious Complications Survey in 2015

Niitsuma

Kusachi

Takesue

et al. 2019

Annals of Gastroent Surgery

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“…9 Antibiotic susceptibility data in 2011 revealed that MRSA isolates from clinical cultures were 97%, 97%, 11%, 97%, 100% and 100% susceptible to trimethoprim/sulfamethoxazole, rifampicin, clindamycin, fusidic acid, linezolid and vancomycin, respectively.…”

Section: Setting and Participantsmentioning

confidence: 99%

Randomized non-inferiority trial to compare trimethoprim/sulfamethoxazole plus rifampicin versus linezolid for the treatment of MRSA infection

Harbarth

Dach

Pagani

et al. 2014

Journal of Antimicrobial Chemotherapy

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Objectives: The therapeutic arsenal for MRSA infections is limited. The aim of this study was to assess the noninferiority of a combination of trimethoprim/sulfamethoxazole plus rifampicin versus linezolid alone for the treatment of MRSA infection. Methods:We conducted a randomized, open-label, single-centre, non-inferiority trial comparing trimethoprim/ sulfamethoxazole (160 mg/800 mg three times daily) plus rifampicin (600 mg once a day) versus linezolid (600 mg twice a day) alone in adult patients with various types of MRSA infection. Patients were allocated 1: 1 to either regimen. The primary outcome was clinical cure at 6 weeks after the end of treatment (non-inferiority margin 20%) assessed by both ITT and PP analyses. Secondary outcomes included the microbiologically documented persistence of MRSA in clinical cultures, mortality and adverse events. The study protocol has been registered with ClinicalTrials.gov (NCT00711854).Results: Overall, 150 patients were randomized to one of the two treatment arms between January 2009 and December 2013 and were included in the ITT analysis. Of these 56/75 (74.7%) in the linezolid group and 59/75 (78.7%) in the trimethoprim/sulfamethoxazole and rifampicin group experienced clinical success (risk difference 4%, 95% CI 29.7% to 17.6%). The results were confirmed by the PP analysis, with 54/66 (81.8%) cured patients in the linezolid group versus 52/59 (88.1%) in the trimethoprim/sulfamethoxazole and rifampicin group (risk difference 6.3%, 95% CI 26.8% to 19.2%). There were no statistically significant differences between the two groups in any of the secondary outcomes, including microbiologically documented failure. Four adverse drug reactions attributed to the study medication occurred in the linezolid group versus nine in the trimethoprim/ sulfamethoxazole and rifampicin group.Conclusions: Compared with linezolid, trimethoprim/sulfamethoxazole and rifampicin seems to be non-inferior in the treatment of MRSA infection.

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“…However, our results suggest that rather than universal screening of all surgical patients admitted for more than 24 h, selective screening in clean surgery wards or a combination of HH promotion and targeted screening of high-risk patients may be more effective strategies. The relative burden of Gram-positive infections is greater in clean compared to clean-contaminated surgery where other pathogens, including bowel flora, may be more important 23 31. Thus, it is biologically plausible that MRSA-specific interventions would potentially have a greater impact in clean surgery.…”

Section: Discussionmentioning

confidence: 99%

Comparison of strategies to reduce meticillin-resistantStaphylococcus aureusrates in surgical patients: a controlled multicentre intervention trial

et al. 2013

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ObjectiveTo compare the effect of two strategies (enhanced hand hygiene vs meticillin-resistant Staphylococcus aureus (MRSA) screening and decolonisation) alone and in combination on MRSA rates in surgical wards.DesignProspective, controlled, interventional cohort study, with 6-month baseline, 12-month intervention and 6-month washout phases.Setting33 surgical wards of 10 hospitals in nine countries in Europe and Israel.ParticipantsAll patients admitted to the enrolled wards for more than 24 h.InterventionsThe two strategies compared were (1) enhanced hand hygiene promotion and (2) universal MRSA screening with contact precautions and decolonisation (intranasal mupirocin and chlorhexidine bathing) of MRSA carriers. Four hospitals were assigned to each intervention and two hospitals combined both strategies, using targeted MRSA screening.Outcome measuresMonthly rates of MRSA clinical cultures per 100 susceptible patients (primary outcome) and MRSA infections per 100 admissions (secondary outcome). Planned subgroup analysis for clean surgery wards was performed.ResultsAfter adjusting for clustering and potential confounders, neither strategy when used alone was associated with significant changes in MRSA rates. Combining both strategies was associated with a reduction in the rate of MRSA clinical cultures of 12% per month (adjusted incidence rate ratios (aIRR) 0.88, 95% CI 0.79 to 0.98). In clean surgery wards, strategy 2 (MRSA screening, contact precautions and decolonisation) was associated with decreasing rates of MRSA clinical cultures (15% monthly decrease, aIRR 0.85, 95% CI 0.74 to 0.97) and MRSA infections (17% monthly decrease, aIRR 0.83, 95% CI 0.69 to 0.99).ConclusionsIn surgical wards with relatively low MRSA prevalence, a combination of enhanced standard and MRSA-specific infection control approaches was required to reduce MRSA rates. Implementation of single interventions was not effective, except in clean surgery wards where MRSA screening coupled with contact precautions and decolonisation was associated with significant reductions in MRSA clinical culture and infection rates.Trial registrationclinicaltrials.gov identifier: NCT00685867

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Epidemiology of Methicillin-Resistant Staphylococcus aureus Carriage and MRSA Surgical Site Infections in Patients Undergoing Colorectal Surgery: A Cohort Study in Two Centers

Cited by 16 publications

References 20 publications

Current status of postoperative infections after digestive surgery in Japan: The Japan Postoperative Infectious Complications Survey in 2015

Current status of postoperative infections after digestive surgery in Japan: The Japan Postoperative Infectious Complications Survey in 2015

Randomized non-inferiority trial to compare trimethoprim/sulfamethoxazole plus rifampicin versus linezolid for the treatment of MRSA infection

Comparison of strategies to reduce meticillin-resistantStaphylococcus aureusrates in surgical patients: a controlled multicentre intervention trial

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