Safety of Targeted Perioperative Mupirocin Treatment for Preventing Infections After Cardiac Surgery

Shrestha, Nabin K.; Banbury, Michael K.; Weber, M; Cwynar, Roberta E.; Lober, Cheryl; Procop, Gary W.; Karafa, Matthew; Gordon, Steven M.

doi:10.1016/j.athoracsur.2006.01.009

Cited by 21 publications

(13 citation statements)

References 21 publications

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“…Studies evaluating the use of perioperative intranasal mupirocin for the prevention of surgical site infection have been performed. Kallen et al 12 and Shrestha et al 20 found several significant differences between the group treated with mupirocin versus the one treated without mupirocin. At the time of the present study, no routines for nasal tests were established at our department.…”

Section: Source Of Infectionsmentioning

confidence: 99%

Infections related to intrathecal baclofen therapy in children and adults: frequency and risk factors

Fjelstad¹,

Hommelstad²,

Sorteberg

2009

PED

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Object The purpose of this study was to determine the frequency of infection and to identify risk factors for infection in connection with the implantation of an intrathecal baclofen (ITB) pump. Methods This retrospective study included all pediatric and adult patients who received ITB at Rikshospitalet during the years 1999–2005. A database was created that included the following variables: patient age, sex, weight, diagnosis, surgical procedure performed, presence of a percutaneous endoscopic gastrostomy (PEG) tube, urinary as well as fecal incontinence, anesthetist's classification of patient status (American Society of Anesthesiologists grade), timing of antibiotics administration, surgeon, assisting nurse, and surgical procedure time. Moreover, the mode of intrathecal screening trial (transcutaneous vs subcutaneous catheter insertion) and any complications were registered. The authors differentiated between deep and superficial infection, and they registered the causative agent. Results A total of 163 patients received ITB; of these, 91 were pediatric patients (median age 10 years), and 72 were adults (median age 44 years). A total of 408 surgical procedures were performed. No infections occurred in direct relation to the screening trials. When a pump was implanted subsequent to a screening trial with transcutaneous catheter insertion, the rate of infection was 9% in the pediatric patients. The corresponding infection rate for pumps implanted after a screening trial with a subcutaneous distal catheter (Albright method) was 12%. This difference was not significant. There was a significantly higher incidence of deep infections following pump implantation in the pediatric group (p = 0.028) than in the adult group. The presence of a PEG tube increased the incidence of infection (p = 0.008) and may be one of the main reasons for a higher frequency of infections in children. When the patient suffered urinary and/or fecal incontinence, there was a higher chance of infection (p = 0.021). The surgical time was significantly longer in the pediatric group than in adults; however, the length of the surgical procedure had no impact on the occurrence of infection. The most common causative agent was Staphylococcus aureus; this microbe was responsible for 69% of deep infections. Also, 69% of deep infections occurred within 1 month after surgery. Conclusions The rate of infection is significantly higher in children undergoing ITB pump implantation than it is in adults. Screening trials applying the Albright method fail to reduce the frequency of infection subsequent to pump implantation. The presence of a PEG tube has the greatest significance as a predictor of infection.

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Section: Source Of Infectionsmentioning

confidence: 99%

Infections related to intrathecal baclofen therapy in children and adults: frequency and risk factors

Fjelstad¹,

Hommelstad²,

Sorteberg

2009

PED

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“…A total of 17 studies were included (12)(13)(14)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36). Since studies (12,13,(30)(31)(32)(33)(34)(35) on targeted mupirocin-based decolonization were not coherent with respect to study groups and data presentation, only a descriptive analysis was performed. Meta-analysis was performed for studies (14,23-29,36) conducting universal decolonization with the mupirocin-based protocol.…”

Section: Resultsmentioning

confidence: 99%

“…The quality of RCTs was high but the overall quality of all remaining studies was low. Owing to their study designs, only two studies recruited patients in the same time period (31,35). Multivariate analysis for confounding factors was performed only by three studies (14,29,34).…”

Section: Resultsmentioning

confidence: 99%

Role of targeted and universal mupirocin‑based decolonization for preventing surgical‑site infections in patients undergoing cardiothoracic surgery: A systematic review and meta‑analysis

Wang

2021

Exp Ther Med

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The purpose of the present study was to provide a systematic literature review and pool evidence on the efficacy of mupirocin-based decolonization protocol in reducing surgical-site infections (SSIs) in patients undergoing cardiothoracic (CT) surgery based on their Staphylococcus ( S .) aureus carrier state. The PubMed, Embase, Ovid, BioMed Central, Cochrane Central Register of Controlled Trials and Google Scholar databases were searched for studies comparing mupirocin-based decolonization with controls for reducing SSIs in patients following CT surgery. Studies were grouped based on the targeted population of intervention, i.e. carriers or all patients. A total of 17 studies were included. Of these, 8 studies used targeted mupirocin-based decolonization, while universal decolonization was performed in 9 studies. The results were conflicting for studies performing targeted decolonization and it was not possible to perform a meta-analysis due to non-homogenous studies. Pooled analysis of 34,859 patients indicated that universal mupirocin-based decolonization significantly reduced the risk of all SSIs [risk ratio (RR): 0.54; 95% CI: 0.40,0.75; I 2 =73.35%]. The intervention significantly reduced the risk of superficial SSIs (RR: 0.37; 95% CI: 0.25,0.55; I 2 =0%) but not of deep SSIs (RR: 0.45; 95% CI: 0.19,1.09; I 2 =80.67%). The results indicated a significantly reduced risk of S. aureus SSIs (SA-SSIs) with mupirocin-based decolonization (RR: 0.44; 95% CI: 0.32,0.61; I 2 =0%) but not for methicillin-resistant S. aureus (MRSA-SSIs; RR: 0.25; 95% CI: 0.05,1.28; I 2 =79.07%). Evidence on the role of targeted mupirocin-based decolonization to reduce SSIs after CT surgery was non-coherent and inconclusive. Analysis of low-quality retrospective studies suggested that universal mupirocin-based decolonization may reduce all SSIs, superficial SSIs and SA-SSIs, but not deep SSIs or MRSA-SSIs in patients after CT surgery.

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“…The Cleveland Clinic Health System includes Cleveland Clinic main campus, a number of regional hospitals in Northeast Ohio, and other distant hospitals. Patients at Cleveland Clinic main campus have been screened for SA carriage since 2002 [4], initially for preoperative carrier identification and decolonization [5], and later for identification and decolonization of carriers in various intensive care units [6]. Screening was initially carried out to identify SA carriage, but as newer tests became available, the information obtained from the screening included methicillin susceptibility in addition to detection of SA.…”

Section: Study Design and Settingmentioning

confidence: 99%

Methicillin resistance in Staphylococcus aureus infections among patients colonized with methicillin-susceptible Staphylococcus aureus

Shrestha

Fraser

Gordon

2019

Clinical Microbiology and Infection

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Safety of Targeted Perioperative Mupirocin Treatment for Preventing Infections After Cardiac Surgery

Cited by 21 publications

References 21 publications

Infections related to intrathecal baclofen therapy in children and adults: frequency and risk factors

Infections related to intrathecal baclofen therapy in children and adults: frequency and risk factors

Role of targeted and universal mupirocin‑based decolonization for preventing surgical‑site infections in patients undergoing cardiothoracic surgery: A systematic review and meta‑analysis

Methicillin resistance in Staphylococcus aureus infections among patients colonized with methicillin-susceptible Staphylococcus aureus

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