Staphylococcus aureus Decolonization as a Prevention Strategy

Simor, Andrew E.; Daneman, Nick

doi:10.1016/j.idc.2008.10.006

Cited by 24 publications

(16 citation statements)

References 101 publications

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“…50 Although S. aureus and MRSA decolonization may be achieved, at least in certain patient populations, further studies are required to identify more effective agents for long-term eradication of nasal and extra-nasal sites of colonization, to evaluate the efficacy of this strategy for preventing infection in various clinical situations, and to determine whether it has any significant role to play as an infection control measure. 54 For example, adequately powered, randomized controlled trials of decolonization for preventing postoperative infections in surgical patients known to be colonized with S. aureus should be conducted. Outcome measures should include overall infection rates and staphylococcal infection rates.…”

Section: Decolonizationmentioning

confidence: 99%

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Prevention strategies for methicillin-resistant Staphylococcus aureus (MRSA) in Latin America

Labarca¹,

Salles²

2010

Braz J Infect Dis

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After the first reports of the emergence of methicillin-resistant Staphylococcus aureus (MRSA) in the 1970s, numerous measures intended to prevent its transmission were initiated in hospitals. However, in most cases, large-scale measures failed to be implemented and the transmission of MRSA has since led to a global pandemic. Presently, doubts still remain about the best approach to prevent and control MRSA and more often than not, control measures are not implemented. Therefore, we review here the current situation in Latin America with respect to existing policies for control of MRSA, and evaluate the evidence for control measures in hospitals and the community. We look at the risk factors for infection and transmission of MRSA between hospital patients and within specific populations in the community, and at the effect of antibiotic usage on the spread of MRSA in these settings. Finally, we summarize recommendations for the prevention and control of MRSA, which can be applied to the Latin American hospital environment and community setting.

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Section: Decolonizationmentioning

confidence: 99%

“…54 The role of decolonization as an infection control intervention to reduce MRSA transmission needs to be defined. Ongoing surveillance of mupirocin resistance should be conducted, especially in settings with repeated or longterm mupirocin use, such as dialysis units.…”

Section: S112mentioning

confidence: 99%

Prevention strategies for methicillin-resistant Staphylococcus aureus (MRSA) in Latin America

Labarca¹,

Salles²

2010

Braz J Infect Dis

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“…Given that most S. aureus skin infections occur from endogenous strains that colonize the infected individual, eradication of the reservoir (ie, decolonization) is expected to reduce recurrence [46]. In the past, the vagina was not considered a common reservoir [46], but studies presented in this article demonstrate that vaginal colonization with S. aureus is common and should be suspected in patients with buttock and genital area MRSA lesions [2••,3••,41•].…”

Section: Antibiotic Resistancementioning

confidence: 99%

“…In the past, the vagina was not considered a common reservoir [46], but studies presented in this article demonstrate that vaginal colonization with S. aureus is common and should be suspected in patients with buttock and genital area MRSA lesions [2••,3••,41•]. In the past, attempts were made to replace colonizing virulent strains of S. aureus with nonvirulent strains, an approach known as "bacterial interference."…”

Section: Antibiotic Resistancementioning

confidence: 99%

MRSA infection of buttocks, vulva, and genital tract in women

Reichman

Sobel²

2009

Curr Infect Dis Rep

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Staphylococcus aureus, although a common commensal bacterium, is a frequent cause of skin and soft tissue infections as well as life-threatening blood stream infections. Resistance to methicillin, which previously was associated with only hospitalized patients, has become a common community-based phenomenon. Less well known is S. aureus vaginal colonization and heterosexual transmission, mainly by skin-mucosa contact. Recognizing the vagina as a reservoir is important and should not be ignored, particularly in women presenting with recurrent genital and buttock boils or if their sexual partner has such infections. Vaginal cultures should be obtained from such women; if the vagina is found to be colonized, eradication of S. aureus from the vagina should be attempted to reduce infection recurrence.

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“…First, the inclusion of a larger proportion of surgical patients who are undergoing elective high-risk procedures could have been beneficial. 18,19 It would be interesting to know why the surgeons were so reluctant to apply topical decolonization treatment even when time permitted its use. Second, the lack of supervision and coordination of MRSA decolonization treatment inside the institution may have modified the effectiveness of the treatment.…”

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confidence: 99%

Methicillin-Resistant Staphylococcus aureus Decolonization “Yes, We Can,” But Will It Help?

Kluytmans

Harbarth

2009

Infect. Control Hosp. Epidemiol.

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Approximately 100,000 invasive methicillin-resistant Staphylococcus aureus (MRSA) infections occurred in 2005 in the United States, and the number of associated deaths was estimated at 19,000, which is more than the corresponding annual number of associated deaths for human immunodeficiency virus (HIV) and AIDS. 1 With the increasing number of community-onset MRSA infections, 2 prevention of staphylococcal infections is now more important than ever.For more than 50 years, it has been known that carriage of S. aureus plays an important role in the pathogenesis of staphylococcal infections and represents a potential target for preventive interventions. One of the first reports (1952) that clearly demonstrated the relationship between S. aureus carriage and subsequent infection involved miners who experienced beat disorders of the knees and elbows. 3 A carefully performed microbiological survey showed that there were 24 "heavy" carriers of S. aureus among 45 beat case patients, compared with 5 heavy carriers among 45 matched control subjects without disease (odds ratio, 9.1 [95% confidence interval {CI}, 3.1-26.5]). Phagetyping showed that, in the majority of cases, the carriage strain matched the strain that caused disease. Hospital-based studies in the 1950s and 1960s confirmed this relationship, especially for surgical patients. 4 More recently, these studies have been repeated in various other patient populations-for example, dialysis patients, patients with HIV, organ transplant recipients, and critically ill patients with intravascular catheters-with similar results. 4 It seems obvious that eradication of S. aureus carriage can reduce the risk for infection. This strategy has been studied in several groups of patients, and a recent Cochrane review aggregated the evidence with regard to the effect of eradication of carriage on the S. aureus infection rate. 5 Eight randomized controlled trials studied the effect of mupirocin nasal ointment in various groups of patients. The pooled estimate showed a significant reduction of the S. aureus infection rate (relative risk [RR], 0.55 [95% CI, 0.43-0.70]; P<.001). An analysis of subgroups showed a pronounced effect on surgical patients and on patients who were receiving dialysis, and this fact confirms results of a previously published systematic review. 6 Recently, a large trial was completed in which patients were screened on hospital admission for S. aureus nasal carriage by means of a 2-hour polymerase chain reaction-based assay, and carriers were subsequently randomly assigned to mupirocin nasal ointment and chlorhexidine skin washings or to placebo. The treated carriers had a significantly lower S. aureus infection rate (RR, 0.42 [95% CI,. 7 In addition, the length of hospital stay was significantly shortened for the group of treated carriers (mean reduction of the length of stay, 1.8 days; P = .04). Despite the evidence that treatment of proven carriers lowers the S. aureus infection risk, there are several issues remaining. Patients who underwent elective surge...

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Staphylococcus aureus Decolonization as a Prevention Strategy

Cited by 24 publications

References 101 publications

Prevention strategies for methicillin-resistant Staphylococcus aureus (MRSA) in Latin America

Prevention strategies for methicillin-resistant Staphylococcus aureus (MRSA) in Latin America

MRSA infection of buttocks, vulva, and genital tract in women

Methicillin-Resistant Staphylococcus aureus Decolonization “Yes, We Can,” But Will It Help?

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