A systematic review of the evidence for interventions for the prevention and control of meticillin-resistant Staphylococcus aureus (1996–2004): report to the Joint MRSA Working Party (Subgroup A)

Loveday, Heather; Pellowe, Carol; Jones, S.R.L.J.; Pratt, Robert

doi:10.1016/j.jhin.2006.01.002

Cited by 97 publications

(56 citation statements)

References 26 publications

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“…However, the efficacy of MRSA decolonization treatment still remains controversial. 8,9 Our study demonstrates that MRSA decolonization with a combination of topical and systemic antimicrobial agents is highly effective for patients completing the full decolonization treatment course. Our decolonization success rate of 87% is higher than most rates that have been reported elsewhere in the literature.…”

Section: Discussionmentioning

confidence: 80%

Highly Effective Regimen for Decolonization of Methicillin-ResistantStaphylococcus aureusCarriers

Buehlmann

Frei

Fenner

et al. 2008

Infect. Control Hosp. Epidemiol.

131

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OBJECTIVE. To evaluate the efficacy of a standardized regimen for decolonization of methicillin-resistant Staphylococcus aureus (MRSA) carriers and to identify factors influencing decolonization treatment failure. SETTING. University hospital with 750 beds and 27,000 admissions/year. PATIENTS. Of 94 consecutive hospitalized patients with MRSA colonization or infection, 32 were excluded because of spontaneous loss of MRSA, contraindications, death, or refusal to participate. In 62 patients, decolonization treatment was completed. At least 6 body sites were screened for MRSA (including by use of rectal swabs) before the start of treatment.INTERVENTIONS. Standardized decolonization treatment consisted of mupirocin nasal ointment, chlorhexidine mouth rinse, and full-body wash with chlorhexidine soap for 5 days. Intestinal and urinary-tract colonization were treated with oral vancomycin and cotrimoxazole, respectively. Vaginal colonization was treated with povidone-iodine or, alternatively, with chlorhexidine ovula or octenidine solution. Other antibiotics were added to the regimen if treatment failed. Successful decolonization was considered to have been achieved if results were negative for 3 consecutive sets of cultures of more than 6 screening sites. ). Decolonization was completed in 87% of patients after a mean (±SD) of 2.1 ± 1.8 decolonization cycles (range, 1-10 cycles). Sixty-five percent of patients ultimately required peroral antibiotic treatment (vancomycin, 52%; cotrimoxazole, 27%; rifampin and fusidic acid, 18%). Decolonization was successful in 54 (87%) of the patients in the intent-to-treat analysis and in 51 (98%) of 52 patients in the on-treatment analysis.CONCLUSION. This standardized regimen for MRSA decolonization was highly effective in patients who completed the full decolonization treatment course. 2008; 29:510-516 In past decades, methicillin-resistant Staphylococcus aureus and outbreaks among injection drug abusers, prisoners, homeless (MRSA) has become the most important multidrug-resistant individuals, sports teams, and children in day care centers. 5,6 pathogen worldwide, causing significant morbidity and increased Studies of surgical patients colonized with methicillinhealthcare costs. Infect Control Hosp Epidemiol1,2 MRSA colonization precedes MRSA infection, susceptible S. aureus have demonstrated that decolonization which occurs in 20%-60% of colonized patients in acute-care treatment-for example, with mupirocin-can reduce the infacilities and in 3%-15% of those in long-term-care facilities. 3 The cidence of subsequent infection. 7 In addition, most authorities rate of nosocomial transmission of MRSA in healthcare facilities recommend that MRSA carriers be decolonized in outbreak can be reduced by the use of strict infection-control measures, situations. such as establishment of MRSA surveillance; early identification MRSA decolonization may reduce the risk of MRSA infecof carriers; isolation of colonized or infected patients; use of bartion in individual carriers and could prevent...

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Section: Discussionmentioning

confidence: 80%

Highly Effective Regimen for Decolonization of Methicillin-ResistantStaphylococcus aureusCarriers

Buehlmann

Frei

Fenner

et al. 2008

Infect. Control Hosp. Epidemiol.

131

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“…Indeed, systematic reviews have identified major methodologic weaknesses in many previous studies, including the lack of concurrent control groups. 6,24,25 More recent studies have yielded mixed results. 14,26 The expanded use of barrier precautions may have been insufficient to reduce the transmission of MRSA or VRE for two reasons.…”

Section: Discussionmentioning

confidence: 99%

Intervention to Reduce Transmission of Resistant Bacteria in Intensive Care

Huskins¹,

Huckabee²,

O’Grady³

et al. 2012

Survey of Anesthesiology

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“…The standard hospital guidelines regarding MRSA prevention stress that "antibiotic-resistant pathogens are sensitive to routinely used hospital disinfectants, but it is essential that correct and meticulous cleaning and use of disinfectants be performed" (648). With few exceptions (408), however, most specific interventions, including the isolation or cohorting of colonized individuals, active identification of MRSA carriage by surveillance cultures of high-risk populations, decolonization of MRSA carriers, environmental disinfection by chemical means or even light (568), or some combination of the above-described interventions, have failed to reliably limit transmission or spread (557). Even with this uncertainty, in community and other institutional settings, there is far less evidence to support the use of these approaches, and as the CA-MRSA epidemic continues, the need for effective interventions has become more acute.…”

Section: Prevention Of Ca-mrsa Infectionsmentioning

confidence: 99%

Community-Associated Methicillin-ResistantStaphylococcus aureus: Epidemiology and Clinical Consequences of an Emerging Epidemic

2010

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SUMMARY Staphylococcus aureus is an important cause of skin and soft-tissue infections (SSTIs), endovascular infections, pneumonia, septic arthritis, endocarditis, osteomyelitis, foreign-body infections, and sepsis. Methicillin-resistant S. aureus (MRSA) isolates were once confined largely to hospitals, other health care environments, and patients frequenting these facilities. Since the mid-1990s, however, there has been an explosion in the number of MRSA infections reported in populations lacking risk factors for exposure to the health care system. This increase in the incidence of MRSA infection has been associated with the recognition of new MRSA clones known as community-associated MRSA (CA-MRSA). CA-MRSA strains differ from the older, health care-associated MRSA strains; they infect a different group of patients, they cause different clinical syndromes, they differ in antimicrobial susceptibility patterns, they spread rapidly among healthy people in the community, and they frequently cause infections in health care environments as well. This review details what is known about the epidemiology of CA-MRSA strains and the clinical spectrum of infectious syndromes associated with them that ranges from a commensal state to severe, overwhelming infection. It also addresses the therapy of these infections and strategies for their prevention.

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A systematic review of the evidence for interventions for the prevention and control of meticillin-resistant Staphylococcus aureus (1996–2004): report to the Joint MRSA Working Party (Subgroup A)

Cited by 97 publications

References 26 publications

Highly Effective Regimen for Decolonization of Methicillin-ResistantStaphylococcus aureusCarriers

Highly Effective Regimen for Decolonization of Methicillin-ResistantStaphylococcus aureusCarriers

Intervention to Reduce Transmission of Resistant Bacteria in Intensive Care

Community-Associated Methicillin-ResistantStaphylococcus aureus: Epidemiology and Clinical Consequences of an Emerging Epidemic

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