Randomized Controlled Trial of Chlorhexidine Gluconate for Washing, Intranasal Mupirocin, and Rifampin and Doxycycline Versus No Treatment for the Eradication of Methicillin-Resistant Staphylococcus aureus Colonization

Simor, Andrew E.; Phillips, Elizabeth; McGeer, Allison; Konvalinka, Ana; Loeb, Mark; Devlin, H. Rosalyn; Kiss, Alex

doi:10.1086/510392

Cited by 259 publications

(157 citation statements)

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…39 The main systemic antimicrobial agents used were vancomycin, rifamycin, fusidic acid and doxycycline. 12,25,32 In the main international guidelines -World Health Organization (WHO), Centers for Disease Control and Prevention (CDC) and the British Society for Antimicrobial Chemotherapy-regarding indications for use of systemic treatments for decolonization, the recommendation is that the drug be chosen based on consultation with the physicians specializing in infectious diseases and epidemiology in each individual hospital. 1,37 In terms of vancomycin, some guidelines contraindicate its use because of the possibility of increasing bacterial resistance to this particular drug.…”

Section: Discussionmentioning

confidence: 99%

“…36 Another systemic drug is doxycycline, which corresponds to an antibacterial agent of the subgroups chloramphenicol and tetracycline. 12 It was used in combination with other topical drugs (mupirocin and chlorhexidine), as well as a systemic drug (rifamycin). This combination achieved effective outcomes, as shown in Chart 1.…”

Section: Discussionmentioning

confidence: 99%

“…[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.…”

Section: Discussionmentioning

confidence: 99%

“…Infections occurring in the community are termed community-acquired MRSA (CA-MRSA). 12 The emergence of CA-MRSA raises serious concerns because there are a growing number of admissions of individuals colonized with this particular strain; hence the community is referred to as a reservoir. Therefore, it was emphasized the importance of promoting interventions to prevent the dissemination of Staphylococcus aureus, particularly MRSA, taking precautions to minimize the transmission of infections caused by this particular microorganism.…”

Section: Introductionmentioning

confidence: 99%

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

Oliveira

Paula

2012

Texto contexto - enferm.

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ABSTRACT:The objective of this article was to establish the main indications, advantages and limitations of the decolonization of patients with Staphylococcus aureus. An integrative literature review was performed on the LILACS, MEDLINE, Science Direct, SCOPUS and Isi Web of Knowledge databases for articles published after 1999. The main indications for decolonization pertained to high-risk patients (admitted to the ICU, post-operative, long stay, etcetera). The advantages were based on the eradication of the microorganism, reducing infection rates and the spread of the microorganism. The observed controversies were due to the possibility of increasing bacterial resistance and lack of scientific evidence regarding the effectiveness of the eradication of the colonizing microorganism, as well as reducing infection rates. Thus, it was observed that decolonization should not be indicated routinely; rather, it should only be recommended for patients at risk and during outbreaks. DESCRIPTORS: Infection control. Methicillin-resistant Staphylococcus aureus. Cross infection. Bacterial drug resistance. DESCOLONIZAÇÃO DE PORTADORES DE STAPHYLOCOCCUS AUREUS:INDICAÇÕES, VANTAGENS E LIMITAÇÕES RESUMO: O objetivo deste artigo foi estabelecer as principais indicações, vantagens e limitações da descolonização de pacientes portadores de Staphylococcus aureus. Procedeu-se a uma revisão integrativa da literatura, com busca de artigos nas bases de dados LILACS, MEDLINE, Science Direct, SCOPUS e Isi Web of Knowledge, e em publicações a partir de 1999. As principais indicações encontradas foram direcionadas aos pacientes considerados de alto risco (admitidos em UTI, submetidos à cirurgia, com longa permanência, etc.). As vantagens fundamentaram-se na erradicação do microrganismo, redução da taxas de infecção e na disseminação destes. As controvérsias se deram pela possibilidade do aumento da resistência bacteriana e pela falta de evidências científicas sobre a eficácia da eliminação do microrganismo colonizante e da redução da taxa de infecção. Observou-se que a descolonização não deve ser indicada como rotina, mas, sim, deve ser recomendada apenas para pacientes de risco e durante surtos. DESCRITORES: Controle de infecções.Staphylococcus aureus resistente à meticilina. Infecção hospitalar. Farmacorresistência bacteriana. DESCOLONIZACIÓN DE PORTADORES DE STAPHYLOCOCCUS AUREUS: INDICACIONES, VENTAJAS Y LIMITACIONES RESUMEN:El objetivo fue establecer las principales indicaciones, ventajas y limitaciones de la descolonización de los pacientes infectados por Staphylococcus aureus. Se realizó una revisión integrativa de literatura, buscando artículos, publicados a partir de 1999, en las bases de datos LILACS, MEDLINE, Science Direct, SCOPUS y el ISI Web of Knowledge. Las principales indicaciones fueron dirigidas a los pacientes de alto riesgo (ingresados en la UCI, sometidos a cirugía, con una estancia de larga duración, etc), los beneficios se fundamentaron en la erradicación y reducción de la propagación de microrganismos y la reducción ...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Oliveira

Paula

2012

Texto contexto - enferm.

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Modeling Interventions to Reduce the Spread of Multidrug-Resistant Organisms Between Health Care Facilities in a Region

et al. 2021

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IMPORTANCE Multidrug-resistant organisms (MDROs) can spread across health care facilities in a region. Because of limited resources, certain interventions can be implemented in only some facilities; thus, decision-makers need to evaluate which interventions may be best to implement. OBJECTIVE To identify a group of target facilities and assess which MDRO intervention would be best to implement in the Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of MDROs in Orange County, a large regional public health collaborative in Orange County, California. DESIGN, SETTING, AND PARTICIPANTS An agent-based model of health care facilities was developed in 2016 to simulate the spread of methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant Enterobacteriaceae (CRE) for 10 years starting in 2010 and to simulate the use of various MDRO interventions for 3 years starting in 2017. All health care facilities (23 hospitals, 5 long-term acute care hospitals, and 74 nursing homes) serving adult inpatients in Orange County, California, were included, and 42 target facilities were identified via network analyses.EXPOSURES Increasing contact precaution effectiveness, increasing interfacility communication about patients' MDRO status, and performing decolonization using antiseptic bathing soap and a nasal product in a specific group of target facilities. MAIN OUTCOMES AND MEASURES MRSA and CRE prevalence and number of new carriers (ie, transmission events).RESULTS Compared with continuing infection control measures used in Orange County as of 2017, increasing contact precaution effectiveness from 40% to 64% in 42 target facilities yielded relative reductions of 0.8% (range, 0.5%-1.1%) in MRSA prevalence and 2.4% (range, 0.8%-4.6%) in CRE prevalence in health care facilities countywide after 3 years, averting 761 new MRSA transmission events (95% CI, 756-765 events) and 166 new CRE transmission events (95% CI, 158-174 events).Increasing interfacility communication of patients' MDRO status to 80% in these target facilities produced no changes in the prevalence or transmission of MRDOs. Implementing decolonization procedures (clearance probability: 39% in hospitals, 27% in long-term acute care facilities, and 3% in nursing homes) yielded a relative reduction of 23.7% (range, 23.5%-23.9%) in MRSA prevalence, averting 3515 new transmission events (95% CI, 3509-3521 events). Increasing the effectiveness of antiseptic bathing soap to 48% yielded a relative reduction of 39.9% (range, 38.5%-41.5%) in CRE prevalence, averting 1435 new transmission events (95% CI, 1427-1442 events). CONCLUSIONS AND RELEVANCEThe findings of this study highlight the ways in which modeling can inform design of regional interventions and suggested that decolonization would be the best (continued) Key Points Question Which multidrug-resistant organism (MDRO) intervention is best to implement in a set of health care facilities to reduce the spread of MDROs regionwide? Findings In this computational simulation modeling study...

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Effect of a Preoperative Decontamination Protocol on Surgical Site Infections in Patients Undergoing Elective Orthopedic Surgery With Hardware Implantation

2015

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Our study demonstrates that preoperative MRSA decontamination with chlorhexidine washcloths and oral rinse and intranasal povidone-iodine decreased the SSI rate by more than 50% among patients undergoing elective orthopedic surgery with hardware implantation. Universal decontamination using this low-cost protocol may be considered as an additional prevention strategy for SSIs in patients undergoing orthopedic surgery with hardware implantation and warrants further study.

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Randomized Controlled Trial of Chlorhexidine Gluconate for Washing, Intranasal Mupirocin, and Rifampin and Doxycycline Versus No Treatment for the Eradication of Methicillin-Resistant Staphylococcus aureus Colonization

Abstract: Treatment with topical mupirocin, chlorhexidine gluconate washes, oral rifampin, and doxycycline for 7 days was safe and effective in eradicating MRSA colonization in hospitalized patients for at least 3 months.

Cited by 259 publications

References 44 publications

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

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

Modeling Interventions to Reduce the Spread of Multidrug-Resistant Organisms Between Health Care Facilities in a Region

Effect of a Preoperative Decontamination Protocol on Surgical Site Infections in Patients Undergoing Elective Orthopedic Surgery With Hardware Implantation

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