Randomized Controlled Trial of Preoperative Topical Decolonization to Reduce Surgical Site Infection for Staphylococcus aureus Nasal Swab–Negative Mohs Micrographic Surgery Patients
Abstract:BACKGROUND
Surgical site infection (SSI) is mainly due to endogenous bacteria. Topical decolonization is a preoperative intervention currently advised for proven nasal carriers of Staphylococcus aureus (S. aureus).
OBJECTIVE
The authors assessed whether topical decolonization could be of benefit for patients who are not nasal carriers of S. aureus.
METHODS AND MATERIALS
The authors performed a randomized con… Show more
“…The remaining 30 studies were subjected to full-text review to exclude those with irrelevant subjects or those that did not fully meet the inclusion criteria. Ultimately, 20 studies were included in the meta-analyses [ 12 – 31 ]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…The pooled results from 20 studies [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] accounting of 10,526 patients showed that nasal decolonization may be associated with a significantly decreased risk of overall SSI in patients after surgery (RR = 0.59, 95% CI Tang et al Ann Clin Microbiol Antimicrob (2020) 19:33 Fig. 3).…”
Section: Nasal Decolonization and The Risk Of Overall Ssis After Surgerymentioning
Aim: To assess the effects of nasal decontamination on preventing surgical site infections (SSIs) in people who are Staphylococcus aureus carriers undergoing different types of surgeries and diverse measures of decolonization. Methods: Relevant randomized controlled trials (RCTs) were identified through systematic searches of the PubMed, Embase, Web of science, and the Cochrane Library databases. The risk ratios (RRs) and 95% confidence intervals (CIs) were calculated and the effects model was chosen according to the heterogeneity. Subgroup analyses were performed according to different types of surgeries and measures of decolonization that Staphylococcus aureus carriers were applied. Results: Twenty RCTs published between 1996 and 2019 involving 10,526 patients were included. Pooled results showed that the overall SSIs and pulmonary surgery SSIs presented with a statistical difference in measures of nasal decontamination (RR = 0.59 and 0.47, respectively, both p < 0.01). However, the associations between nasal decolonization and increased risks of SSIs in orthopedics surgery or cardiovascular surgery remained insignificant in studies. As for the diverse measures of nasal decontamination, 50% used mupirocin, 15% used chlorhexidine, 30% used different types of antimicrobial drugs, and 5% use others. The SSIs rate were decreased after chlorhexidine (RR = 0.474, 95% CI 0.259-0.864), while no significant difference was shown in the use of mupirocin (RR = 0.871, 95% CI 0.544-1.394). Conclusion: It seems that nasal decolonization of Staphylococcus aureus may be associated with a reduction of SSIs in these patients, especially in patients who have been administered by pulmonary surgeries or treated with chlorhexidine.
“…The remaining 30 studies were subjected to full-text review to exclude those with irrelevant subjects or those that did not fully meet the inclusion criteria. Ultimately, 20 studies were included in the meta-analyses [ 12 – 31 ]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…The pooled results from 20 studies [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] accounting of 10,526 patients showed that nasal decolonization may be associated with a significantly decreased risk of overall SSI in patients after surgery (RR = 0.59, 95% CI Tang et al Ann Clin Microbiol Antimicrob (2020) 19:33 Fig. 3).…”
Section: Nasal Decolonization and The Risk Of Overall Ssis After Surgerymentioning
Aim: To assess the effects of nasal decontamination on preventing surgical site infections (SSIs) in people who are Staphylococcus aureus carriers undergoing different types of surgeries and diverse measures of decolonization. Methods: Relevant randomized controlled trials (RCTs) were identified through systematic searches of the PubMed, Embase, Web of science, and the Cochrane Library databases. The risk ratios (RRs) and 95% confidence intervals (CIs) were calculated and the effects model was chosen according to the heterogeneity. Subgroup analyses were performed according to different types of surgeries and measures of decolonization that Staphylococcus aureus carriers were applied. Results: Twenty RCTs published between 1996 and 2019 involving 10,526 patients were included. Pooled results showed that the overall SSIs and pulmonary surgery SSIs presented with a statistical difference in measures of nasal decontamination (RR = 0.59 and 0.47, respectively, both p < 0.01). However, the associations between nasal decolonization and increased risks of SSIs in orthopedics surgery or cardiovascular surgery remained insignificant in studies. As for the diverse measures of nasal decontamination, 50% used mupirocin, 15% used chlorhexidine, 30% used different types of antimicrobial drugs, and 5% use others. The SSIs rate were decreased after chlorhexidine (RR = 0.474, 95% CI 0.259-0.864), while no significant difference was shown in the use of mupirocin (RR = 0.871, 95% CI 0.544-1.394). Conclusion: It seems that nasal decolonization of Staphylococcus aureus may be associated with a reduction of SSIs in these patients, especially in patients who have been administered by pulmonary surgeries or treated with chlorhexidine.
“…The characteristics of the included studies are presented in Table 1. The studies were published between 1996 and 2019 and performed in the United States 14,17,18,21,24,26 , Netherlands 16,[28][29][30] , and Australia 19,23,31 . Besides, the quality of included articles according to Cochrane's Book was shown in Figure 2.…”
Section: Study Characteristics and Quality Assessmentmentioning
confidence: 99%
“…The pooled results from 20 studies [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] accounting of 10526 patients showed that nasal decolonization may be associated with a signi cantly decreased risk of overall SSI in patients after surgery (RR=0.59, 95% CI: 0.38−0.90; Figure 3). Random effects model was chosen to balance the statistical heterogeneity (p for Cochrane's Q test=0.000, I 2 =75.8%).…”
Section: Nasal Decolonization and The Risk Of Overall Ssis After Surgerymentioning
Aim: To assess the effects of nasal decontamination on preventing surgical site infections (SSIs) in people who are Staphylococcus aureus carriers undergoing different types of surgeries and diverse measures of decolonization. Methods: Relevant randomized controlled trials (RCTs) were identified through systematic searches of the PubMed, Embase, Web of science, and the Cochrane Library databases. The risk ratios (RRs) and 95% confidence intervals (CIs) were calculated and the effects model was chosen according to the heterogeneity. Subgroup analyses were performed according to different types of surgeries and measures of decolonization that Staphylococcus aureus carriers were applied.Results: Twenty RCTs published between 1996 and 2019 involving 10526 patients were included. Pooled results showed that the overall SSIs and pulmonary surgery SSIs presented with a statistical difference in measures of nasal decontamination (RR=0.59 and 0.47, respectively, both p<0.01). However, the associations between nasal decolonization and increased risks of SSIs in orthopedics surgery or cardiovascular surgery remained insignificant in studies. As for the diverse measures of nasal decontamination, 50% used mupirocin, 15% used chlorhexidine, 30% used different types of antimicrobial drugs, and 5% use others. The SSIs rate were decreased after chlorhexidine (RR=0.474, 95% CI: 0.259-0.864), while no significant difference was shown in the use of mupirocin (RR=0.871, 95% CI: 0.544-1.394).Conclusion: It seems that nasal decolonization of Staphylococcus aureus may be associated with a reduction of SSIs in these patients, especially in patients who have been administered by pulmonary surgeries or treated with chlorhexidine.
“…The decontamination regime for MSSA was largely adapted from MRSA. As a MSSA specific national recommendation is lacking, the decontamination protocol was created in accordance with relevant international publications and expertise of clinical hygienists [4,7,21,22].…”
Background: Surgical site infections (SSI) are the most common health care associated infections in German acute hospitals and can result in prolonged hospital stays, increased use of antibiotics and utilisation of care. Staphylococcus aureus bacteria (methicillin-resistant S Aureus (MRSA) and methicillin-susceptible S Aureus (MSSA)) are amongst the most prominent causes of SSI. While up to 90% of documented S Aureus colonization is already detectable prior to hospital admission, the majority of hygiene measures in Germany is focused on the hospital setting. It is hypothesized that early detection and decontamination of S Aureus colonization in primary care can prevent health care associated infections and reduce the number of S Aureus isolates in the hospital setting.Methods: This study is a controlled interventional study (N = 13,260) with a pre-post comparison. The intersectoral intervention (over 2 years) will encompass the following elements: ambulatory detection and decontamination of MRSA and MSSA prior to elective surgery combined with a structured follow-up care. Patients from the control group will be screened in the hospital setting, in accordance with the standard operating procedure (SOP) in routine care. The primary endpoint is the reduction of MRSA and MSSA colonization upon hospital admission. Secondary endpoints are complication rate (SSI), length of stay, recolonization of patients (3 and 6 months after release), patient and provider satisfaction, patient compliance and cost development. Discussion: In case of positive results, the chance of a widespread uptake and implementation in routine care are considered high. The active involvement of primary care providers in the implementation of screening and decontamination as well as follow-up care is a unique feature of this study. The positive resonance of primary care providers during the recruitment phase highlights the relevance of the topic to the participating actors. These efforts are coupled with patient education and specifically trained medical staff, promising a sustained impact. The STAUfrei care pathway can homogenize current practices in routine care and provide a template for further intersectoral cooperation.
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