An algorithm for the management of Staphylococcus aureus carriage within patients with recurrent staphylococcal skin infections

Tzermpos, Fotios; Kanni, Theodora; Tzanetakou, Vassiliki; Papadimas, Christos; Antonopoulou, Anastasia; Savva, Athina; Theologie-Lygidakis, Nadia; Giamarellos‐Bourboulis, Evangelos J.

doi:10.1007/s10156-013-0564-2

Cited by 12 publications

(10 citation statements)

References 13 publications

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“…Clindamycin has been used as a component of MRSA decolonization bundles owing to its activity against MRSA with eradication rates of up to 90%. 30,31 Several other agents have also been studied as part of combination antibiotic treatment for MRSA colonization eradication, including doxycycline 31,32 and trimethoprim-sulfamethoxazole. 31 These antibiotics were not associated with decreased risk of recurrence in our study, however.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Recurrent Colonization With Methicillin-ResistantStaphylococcus aureusin Community-Dwelling Adults and Children

Cluzet

Gerber

Nachamkin

et al. 2015

Infect. Control Hosp. Epidemiol.

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OBJECTIVE To identify risk factors for recurrent methicillin-resistant Staphylococcus aureus (MRSA) colonization. DESIGN Prospective cohort study conducted from January 1, 2010, through December 31, 2012. SETTING Five adult and pediatric academic medical centers. PARTICIPANTS Subjects (ie, index cases) who presented with acute community-onset MRSA skin and soft-tissue infection. METHODS Index cases and all household members performed self-sampling for MRSA colonization every 2 weeks for 6 months. Clearance of colonization was defined as 2 consecutive sampling periods with negative surveillance cultures. Recurrent colonization was defined as any positive MRSA surveillance culture after clearance. Index cases with recurrent MRSA colonization were compared with those without recurrence on the basis of antibiotic exposure, household demographic characteristics, and presence of MRSA colonization in household members. RESULTS The study cohort comprised 195 index cases; recurrent MRSA colonization occurred in 85 (43.6%). Median time to recurrence was 53 days (interquartile range, 36-84 days). Treatment with clindamycin was associated with lower risk of recurrence (odds ratio, 0.52; 95% CI, 0.29-0.93). Higher percentage of household members younger than 18 was associated with increased risk of recurrence (odds ratio, 1.01; 95% CI, 1.00-1.02). The association between MRSA colonization in household members and recurrent colonization in index cases did not reach statistical significance in primary analyses. CONCLUSION A large proportion of patients initially presenting with MRSA skin and soft-tissue infection will have recurrent colonization after clearance. The reduced rate of recurrent colonization associated with clindamycin may indicate a unique role for this antibiotic in the treatment of such infection.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Recurrent Colonization With Methicillin-ResistantStaphylococcus aureusin Community-Dwelling Adults and Children

Cluzet

Gerber

Nachamkin

et al. 2015

Infect. Control Hosp. Epidemiol.

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“…Skin and mucosal carriage of S. aureus, which is found in 20-30% of people (Sollid et al, 2014;Brown et al, 2014), increases the risk of such infections. Skin carriage still may persist in 15% of patients despite treatment based on sophisticated algorithms (Tzermpos et al, 2013) using decolonisation protocols (Longtin et al, 2009). Interestingly, this S. aureus carriage is not necessarily monoclonal, as different strains can coexist (Zürcher-Pfund et al, 2013;Betz et al, 2015;Landelle et al, 2014) and can also be found with coagulase-negative staphylococci.…”

Section: Discussionmentioning

confidence: 99%

“…We only enrolled patients in this study who had a soft tissue infection, which we defined as the presence of intraoperative pus, together with other symptoms (new onset of fever or local pain, warmth, redness or discharge). In seeking evidence of subsequent soft tissue infections after the index case, we excluded recurrent infection episodes, recurrent furunculosis (Sollid et al, 2014;Tzermpos et al, 2013), implant-related infections, and osteoarticular infections (Ferry et al, 2010;Post et al, 2014). A recurrence was defined has the clinical re-apparition of the same infection by the same pathogen at the same anatomical place due to failure of initial therapy.…”

Section: Study Definitions and Criteriamentioning

confidence: 99%

“…There are no published data on whether or not long-term S. aureus carriage increases the risk of subsequent infection S. aureus other than in $ All authors declare no financial support, grants, financial interests or consultancy that could lead to conflicts of interest. The information has been presented in part at the 6 th Oxford Bone and Joint Infection Conference (OBIC), September 2016, Oxford, United Kingdom, and the Swiss Annual Meeting of Infectious Diseases, September 2016, Montreux, Switzerland. the perioperative setting or with the unusual entity of recurrent furunculosis (Sollid et al, 2014;Tzermpos et al, 2013). Specifically, it is unknown if a patient who has a soft tissue infection caused by S. aureus (as opposed to another pathogen) is at greater risk for another soft tissue infection (caused by S. aureus or another pathogen) during his or her lifetime.…”

Section: Introductionmentioning

confidence: 99%

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Staphylococcus aureus soft tissue infection may increase the risk of subsequent staphylococcal soft tissue infections

Bouvet

Gjoni

Zenelaj

et al. 2017

International Journal of Infectious Diseases

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Background: Staphylococcus aureus is the most common cause of soft tissue infections. It is unknown, however, if a patient who has had such an infection is at greater risk for future soft tissue infections with S. aureus. Methods: We conducted an epidemiological survey of adult patients hospitalized in the only public hospital in Geneva for treatment (usually combined surgical and medical) of a soft tissue infection caused by S. aureus. By reviewing nursing and medical records from the emergency department and hospital wards, we assessed whether or not they developed any other soft tissue infections (excluding a recurrence) after or before the index one. Results: Among 1023 index episodes of soft tissue infections, 670 (65%) were caused by S. aureus, of which 47 were caused by methicillin-resistant strains (30 healthcare-associated and 17 community-acquired). The patients' median age was 51 years and 334 (34%) were immune-compromised. The median time span between the patient's first and last consultation (for any reason) in our hospital was 21.4 years (interquartile range, 10-30 years). In addition to their index infection, 124 patients (12%) developed a new nosocomial or community-acquired soft tissue infection. Among the index cases with an S. aureus infection, 92 (14%) had another soft tissue infection, compared to 32 (9%) who had a non-staphylococcal index infection (Pearson-x 2-test; p = 0.03). Similarly, patients with an index S. aureus infection, compared to those with a non-S. aureus infection, had a higher rate of another soft tissue infection caused by S. aureus (x 2-test; p < 0.01). In multivariate analysis, an index infection due to S. aureus shows a high association to further S. aureus soft tissue infections (logistic regression; odds ratio 2.5, 95% confidence interval 1.4-4.6). Conclusion: Among adult patients hospitalised for a soft tissue infection, those infected with S. aureus (compared with other pathogens) may be at higher risk of a subsequent soft tissue infection, particularly with S. aureus.

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“…7,8 Approaches have included preventing transmission of SA by actively screening and isolating colonized infants 9 and attempting to eradicate SA in infants who have become colonized using nasal and/or topical antimicrobial agents, such as mupirocin and chlorhexidine. 10,11 In most interventions, researchers have targeted methicillin-resistant S aureus (MRSA) without concern for methicillin-susceptible S aureus (MSSA) because treatment options for MRSA are more limited, and some data suggest that MRSA infections are more severe. 12 In the NICU, morbidity and mortality from MRSA and MSSA appear equivalent.…”

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confidence: 99%

Mupirocin for Staphylococcus aureus Decolonization of Infants in Neonatal Intensive Care Units

et al. 2019

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BACKGROUND AND OBJECTIVES: Staphylococcus aureus (SA) is the second leading cause of lateonset sepsis among infants in the NICU. Because colonization of nasal mucosa and/or skin frequently precedes invasive infection, decolonization strategies, such as mupirocin application, have been attempted to prevent clinical infection, but data supporting this approach in infants are limited. We conducted a phase 2 multicenter, open-label, randomized trial to assess the safety and efficacy of intranasal plus topical mupirocin in eradicating SA colonization in critically ill infants. METHODS:Between April 2014 and May 2016, infants <24 months old in the NICU at 8 study centers underwent serial screening for nasal SA. Colonized infants who met eligibility criteria were randomly assigned to receive 5 days of mupirocin versus no mupirocin to the intranasal, periumbilical, and perianal areas. Mupirocin effects on primary (day 8) and persistent (day 22) decolonization at all three body sites were assessed. RESULTS:A total of 155 infants were randomly assigned. Mupirocin was generally well tolerated, but rashes (usually mild and perianal) occurred significantly more often in treated versus untreated infants. Primary decolonization occurred in 62 of 66 (93.9%) treated infants and 3 of 64 (4.7%) control infants (P < .001). Twenty-one of 46 (45.7%) treated infants were persistently decolonized compared with 1 of 48 (2.1%) controls (P < .001). CONCLUSIONS:Application of mupirocin to multiple body sites was safe and efficacious in eradicating SA carriage among infants in the NICU; however, after 2 to 3 weeks, many infants who remained hospitalized became recolonized. abstract NIH

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An algorithm for the management of Staphylococcus aureus carriage within patients with recurrent staphylococcal skin infections

Cited by 12 publications

References 13 publications

Risk Factors for Recurrent Colonization With Methicillin-ResistantStaphylococcus aureusin Community-Dwelling Adults and Children

Risk Factors for Recurrent Colonization With Methicillin-ResistantStaphylococcus aureusin Community-Dwelling Adults and Children

Staphylococcus aureus soft tissue infection may increase the risk of subsequent staphylococcal soft tissue infections

Mupirocin for Staphylococcus aureus Decolonization of Infants in Neonatal Intensive Care Units

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