Targeted Versus Universal Decolonization to Prevent ICU Infection

Huang, Susan S.; Septimus, Edward; Kleinman, Ken; Moody, Julia; Hickok, Jason; Avery, Taliser R.; Lankiewicz, Julie; Gombosev, Adrijana; Terpstra, Leah; Hartford, Fallon; Hayden, Mary K; Jernigan, John A.; Weinstein, Robert A.; Fraser, Victoria J.; Haffenreffer, Katherine; Cui, Eric; Kaganov, Rebecca E.; Lolans, Karen; Perlin, Jonathan B.; Platt, Richard

doi:10.1097/01.sa.0000441041.37323.f9

Cited by 67 publications

(96 citation statements)

References 28 publications

(34 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Zusätzlich sind in jüngster Zeit verschiedene Studien erschienen, die neben MRSA-spezifischen Maßnahmen universelle, erregerunabhängige Dekolonisationsmaßnahmen untersucht haben [365][366][367][368]. Dieser "horizontale" Ansatz der Infektionsprävention ist nicht patienten- [370][371][372].…”

Section: B) Tragen Von Schutzkleidung Bei Patientenkontaktunclassified

Empfehlungen zur Prävention und Kontrolle von Methicillin-resistenten Staphylococcus aureus-Stämmen (MRSA) in medizinischen und pflegerischen Einrichtungen

Ruscher

2014

Bundesgesundheitsbl.

122

View full text Add to dashboard Cite

Section: B) Tragen Von Schutzkleidung Bei Patientenkontaktunclassified

Empfehlungen zur Prävention und Kontrolle von Methicillin-resistenten Staphylococcus aureus-Stämmen (MRSA) in medizinischen und pflegerischen Einrichtungen

Ruscher

2014

Bundesgesundheitsbl.

122

View full text Add to dashboard Cite

“…The authors of the guidelines noted that pretransplant MRSA screening and decolonization may have a role in limiting infections; however, optimal time is yet undefined and results may vary depending on the organ transplanted and whether it is a living versus deceased donor organ transplantation (3). Indeed, MRSA carriers may benefit from decolonization strategies that include nasal mupirocin and chlorhexidine bathing, as seen in the paradigm of ICU patients (41), whereas prevention measures may be inefficient for VRE acquisition (42). Also, decolonization policies may be considered presumably applicable, as their benefits are documented in other high-risk groups (3).…”

Section: Discussionmentioning

confidence: 99%

MRSA and VRE Colonization in Solid Organ Transplantation: A Meta-Analysis of Published Studies

Ziakas

Pliakos

Zervou

et al. 2014

American Journal of Transplantation

100

View full text Add to dashboard Cite

The burden of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE) colonization among the increasing number of solid organ transplant patients has not been systematically explored. We searched PubMed and EMBASE for pertinent articles, performed a metaanalysis of prevalence across eligible studies and estimated the risk of ensuing MRSA or VRE infections relative to colonization status. We stratified effects in the pretransplant and posttransplant period. Twentythree studies were considered eligible. Seventeen out of 23 (74%) referred to liver transplants. Before transplantation, the pooled prevalence estimate for MRSA and VRE was 8.5% (95% confidence interval [CI] 3.2-15.8) and 11.9% (95% CI 6.8-18.2), respectively. MRSA estimate was influenced by small studies and was lower (4.0%; 95% CI 0.4-10.2) across large studies (>200 patients). After transplantation, the prevalence estimates were 9.4% (95% CI 3.0-18.5) for MRSA and 16.2% (95% CI 10.7-22.6) for VRE. Pretransplant as well as posttransplant MRSA colonization significantly increased the risk for MRSA infections (pooled risk ratio [RR] 5.51; 95% CI 2. respectively). Pretransplant and posttransplant VRE colonization were also associated with significant risk of VRE infection (RR 6.65; respectively). Solid organ transplantation is a high-risk setting for MRSA and VRE colonization, and carrier state is associated with infection. Upgraded focus in prevention and eradication strategies is warranted.

show abstract

“…Our estimated rate of cross-transmission appears higher in spite of aggressive mandatory screening for VRE and MRSA coupled with isolation of patients testing positive for either organism. However, there is some evidence that isolation alone may not reduce rates of infection because of crosstransmission [7,10]. Given greater estimated rates of crosstransmission we may have expected greater mortality rates.…”

Section: Discussionmentioning

confidence: 99%

Whence Resistance?

Guidry

Davies

Metzger

et al. 2015

Surgical Infections

View full text Add to dashboard Cite

Background: Antimicrobial resistance results from a complex interaction between pathogenic and non-pathogenic bacteria, antimicrobial pressure, and genes, which together comprise the total body of potential resistance elements. The purpose of this study is to review and evaluate the importance of antimicrobial pressure on the development of resistance in a single surgical intensive care unit. Methods: We reviewed a prospectively collected dataset of all intensive care unit (ICU)-acquired infections in surgical and trauma patients over a 6-y period at a single hospital. Resistant gram-negative pathogens (rGNR) included those resistant to all aminoglycosides, quinolones, penicillins, cephalosporins, or carbapenems; resistant gram-positive infections (rGPC) included methicillin-resistant Staphylococcus aureus (MRSA) or vancomycinresistant enterococci (VRE). Each resistant infection was evaluated for prior or concomitant antibiotic use, previous treatment for the same (non-resistant) organism, and concurrent infection with the same organism (genus and species, although not necessarily resistant) in another ICU patient. Results: Three hundred and thirty resistant infections were identified: 237 rGNR and 93 rGPC. Infections with rGNR occurred frequently while receiving antibiotic therapy (65%), including the sensitive form of the subsequent resistant pathogen (42.2%). Infections with rGPC were also likely to occur on antimicrobial therapy (50.6%). Treatment of a different patient for an infection with the same resistant pathogen in the ICU at the time of diagnosis, implying potential patient-to-patient transmission occurred more frequently with rGNR infections (38.8%). Conclusion: Antimicrobial pressure exerts a substantial effect on the development of subsequent infection. Our data demonstrate a high estimated rate of de novo emergence of resistance after treatment, which appears to be more common than patient-to-patient transmission. These data support the concept that efforts to limit antimicrobial usage will be more efficacious than enhanced isolation procedures when trying to reduce antimicrobial resistance.

show abstract

Targeted Versus Universal Decolonization to Prevent ICU Infection

Cited by 67 publications

References 28 publications

Empfehlungen zur Prävention und Kontrolle von Methicillin-resistenten Staphylococcus aureus-Stämmen (MRSA) in medizinischen und pflegerischen Einrichtungen

Empfehlungen zur Prävention und Kontrolle von Methicillin-resistenten Staphylococcus aureus-Stämmen (MRSA) in medizinischen und pflegerischen Einrichtungen

MRSA and VRE Colonization in Solid Organ Transplantation: A Meta-Analysis of Published Studies

Whence Resistance?

Contact Info

Product

Resources

About