The Persistence of Staphylococcus aureus Decolonization After Mupirocin and Topical Chlorhexidine: Implications for Patients Requiring Multiple or Delayed Procedures

Immerman, Igor; Ramos, Nicholas; Katz, Grégory; Hutzler, Lorraine; Phillips, Michael; Bosco, Joseph

doi:10.1016/j.arth.2012.01.010

Cited by 39 publications

(14 citation statements)

References 24 publications

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“…This rate is consistent with the only other study in the arthroplasty literature, which demonstrated that 30% of patients decolonized before elective arthroplasty were colonized on subsequent nasal swabbing at a mean of 213 days [11]. This rate is also in general accordance with previous nonarthroplasty population studies revealing persistence after decolonization protocols of approximately 20%-30% [6,22].…”

Section: Discussionsupporting

confidence: 82%

“…Investigations in the nonarthroplasty literature suggest that patients undergoing S. aureus decolonization may nevertheless demonstrate later evidence of persistent colonization and may be at an increased risk of late-onset infection. There is only one report in the arthroplasty literature describing the longer-term S. aureus colonization status among patients who were decolonized before arthroplasty [11]. The purpose of this pilot study was to determine the percentage of postoperative arthroplasty patients with S. aureus colonization despite previous decolonization at the time of TJA.…”

Section: Discussionmentioning

confidence: 99%

“…These studies have all shown a major decline in SSIs with the use of decolonization protocols, which has generated much interest in their use [9,13,21]. However, to our knowledge, there is only one article within the TJA literature detailing the persistence of nasal methicillin-sensitive S. aureus (MSSA)/MRSA colonization after a decolonization protocol has been used: Immerman et al [11] showed that at an average interval of 213 days postoperatively, 30% of their patients were not decolonized after a decolonization protocol of mupirocin and chlorhexidine.…”

Section: Introductionmentioning

confidence: 99%

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Staphylococcus aureus Colonization among Arthroplasty Patients Previously Treated by a Decolonization Protocol: A Pilot Study

Economedes

Deirmengian

2013

Clinical Orthopaedics &Amp; Related Research

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Background Although testing and treatment for Staphylococcus aureus colonization before total joint arthroplasty (TJA) are well described and understood, the durability of decolonization has not been studied extensively. Questions/purposes The purpose of this pilot study is to determine the percentage of arthroplasty patients with S. aureus colonization despite previous decolonization at the time of TJA. Methods Over a 2-year period, all patients having TJA by one surgeon were screened and treated for nasal S. aureus. Of 634 patients, 139 had methicillin-sensitive S. aureus (15%) or methicillin-resistant S. aureus (6.6%) colonization before TJA. Fifty-eight of these 139 patients (42%) were retested at 3 to 30 months for persistent colonization by nasal culture. Data collection included age at time of TJA, type of TJA, and time from TJA to repeat testing. We performed no clonal analysis for strains. Results Thirty-nine of the 58 patients (67%) decolonized before surgery were negative on retesting and 19 (33%) were again positive for S. aureus colonization. Of the 19 patients who retested positive for colonization, 17 (89%) were colonized by bacteria with unchanged antibiotic sensitivity. Conclusions We demonstrate that 33%

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Staphylococcus aureus Colonization among Arthroplasty Patients Previously Treated by a Decolonization Protocol: A Pilot Study

Economedes

Deirmengian

2013

Clinical Orthopaedics &Amp; Related Research

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“…51 It should be noted that the decolonization is not permanent, and patients who are decolonized have a significant risk of being recolonized. 52 This means that patients decolonized for a procedure will need to be rescreened if they undergo a second procedure or if their surgery is postponed. Additional studies are needed to determine the ideal screening and decolonization protocol and whether it is the decolonization process itself, administration of vancomycin for MRSA-colonized patients, or a combination of the two that is driving the trend of reduced infection rates.…”

Section: Staphylococcus Aureus Carrier Screening and Decolonizationmentioning

confidence: 99%

Principles of Antibiotic Prophylaxis in Total Joint Arthroplasty

Bosco

Bookman

Slover

et al. 2015

Journal of the American Academy of Orthopaedic Surgeons

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Infection is a rare, serious complication following total joint arthroplasty and constitutes a considerable emotional and financial burden for patients, surgeons, and healthcare systems. Prevention of surgical site and periprosthetic joint infections is crucial. This requires knowledge of the microorganisms that commonly cause these infections, including Staphylococcus species. Selection of the appropriate antibiotic regimen to treat infection remains controversial, but cefazolin and cefuroxime are the most commonly recommended antibiotics for prophylaxis. Appropriate timing of administration before surgery, with redosing performed as needed, can help to ensure optimal antibiotic concentration during surgery. Given the increasing evidence that S aureus colonization is a risk factor for periprosthetic joint infection, an exploration of the potential benefits of preoperative S aureus carrier screening and decolonization protocols is warranted. The use of antibiotic-loaded bone cement in primary total joint arthroplasty and antibiotic powder at wound closure are other controversial topics that require additional research.

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“…Studies have found that patients tend to become recolonized with S. aureus within weeks or months of being decolonized (51,52). In fact, S. aureus recolonization rates at 1 year approached 50% for health care workers and 75% for patients on peritoneal dialysis (53).…”

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confidence: 99%

Decolonization in Prevention of Health Care-Associated Infections

2016

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SUMMARYColonization with health care-associated pathogens such asStaphylococcus aureus, enterococci, Gram-negative organisms, andClostridium difficileis associated with increased risk of infection. Decolonization is an evidence-based intervention that can be used to prevent health care-associated infections (HAIs). This review evaluates agents used for nasal topical decolonization, topical (e.g., skin) decolonization, oral decolonization, and selective digestive or oropharyngeal decontamination. Although the majority of studies performed to date have focused onS. aureusdecolonization, there is increasing interest in how to apply decolonization strategies to reduce infections due to Gram-negative organisms, especially those that are multidrug resistant. Nasal topical decolonization agents reviewed include mupirocin, bacitracin, retapamulin, povidone-iodine, alcohol-based nasal antiseptic, tea tree oil, photodynamic therapy, omiganan pentahydrochloride, and lysostaphin. Mupirocin is still the gold standard agent forS. aureusnasal decolonization, but there is concern about mupirocin resistance, and alternative agents are needed. Of the other nasal decolonization agents, large clinical trials are still needed to evaluate the effectiveness of retapamulin, povidone-iodine, alcohol-based nasal antiseptic, tea tree oil, omiganan pentahydrochloride, and lysostaphin. Given inferior outcomes and increased risk of allergic dermatitis, the use of bacitracin-containing compounds cannot be recommended as a decolonization strategy. Topical decolonization agents reviewed included chlorhexidine gluconate (CHG), hexachlorophane, povidone-iodine, triclosan, and sodium hypochlorite. Of these, CHG is the skin decolonization agent that has the strongest evidence base, and sodium hypochlorite can also be recommended. CHG is associated with prevention of infections due to Gram-positive and Gram-negative organisms as well asCandida. Conversely, triclosan use is discouraged, and topical decolonization with hexachlorophane and povidone-iodine cannot be recommended at this time. There is also evidence to support use of selective digestive decontamination and selective oropharyngeal decontamination, but additional studies are needed to assess resistance to these agents, especially selection for resistance among Gram-negative organisms. The strongest evidence for decolonization is for use among surgical patients as a strategy to prevent surgical site infections.

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The Persistence of Staphylococcus aureus Decolonization After Mupirocin and Topical Chlorhexidine: Implications for Patients Requiring Multiple or Delayed Procedures

Cited by 39 publications

References 24 publications

Staphylococcus aureus Colonization among Arthroplasty Patients Previously Treated by a Decolonization Protocol: A Pilot Study

Staphylococcus aureus Colonization among Arthroplasty Patients Previously Treated by a Decolonization Protocol: A Pilot Study

Principles of Antibiotic Prophylaxis in Total Joint Arthroplasty

Decolonization in Prevention of Health Care-Associated Infections

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