Highly Effective Regimen for Decolonization of Methicillin-ResistantStaphylococcus aureusCarriers

Abstract

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...

Descolonização de portadores de Staphylococcus aureus: indicações, vantagens e limitações

“…[43][44] The latter is used more frequently, and in the analyzed studies regarding decolonization, they were always used in combination with other drugs and proved to be effective. [20][21][22][23]25 The other analyzed drugs -tea tree oil, prontoderm and polysporin -do not appear in any of the analyzed guidelines. However, with the emergence of resistance to the commonly used drugs and the search for new antimicrobial agents, they may be seen as alternative treatments for the decolonization process of patients in the battle against bacterial resistance.…”

“…In general, topical drugs are more commonly used as decontamination agents. 12,23,36,37 This occurs mainly because of the concern regarding the emergence of strains resistant to antimicrobial agents. 39 The main systemic antimicrobial agents used were vancomycin, rifamycin, fusidic acid and doxycycline.…”

“…[10][11][12][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]33 Nasal mupirocin is considered the best topical agent for the eradication of gram-positive bacteria immediately following the treatment, when the adherence to this protocol is high. 35 As shown in chart 1, 68.8% of the studies that used topical mupirocin for patient decolonization achieved an effective outcome.…”

Reingreso por infección de sitio quirúrgico: una revisión integradora

“…La literatura científica 32 , muestra que aproximadamente dos tercios de las ISQ asociadas a implantes son causados por Staphylococcus spp. Estos agentes están presentes en individuos sanos y normalmente colonizan la piel y la nariz, aunque un estudio reciente demostró colonización de la región inguinal, recto, tracto urinario y vagina 33 . Boethelmann y cols.…”

“…Boethelmann y cols. 33 proponen, como forma de reducir las ISQ por esos agentes, la higienización de la piel en el preoperatorio del paciente con gluconato de clorhexidina 2% por su acción antiséptica residual sobre la piel y el tratamiento con mupirocina, en el caso de pacientes identificados como portadores de S. aureus resistente a meticilina (oxacilina).…”