Duration of Colonization and Determinants of Earlier Clearance of Colonization With Methicillin-Resistant Staphylococcus aureus

Cluzet, Valerie; Gerber, Jeffrey S.; Nachamkin, Irving; Metlay, Joshua P.; Zaoutis, Theoklis E.; Davis, Meghan F.; Julian, Kathleen G.; Royer, David; Linkin, Darren R.; Coffin, Susan; Margolis, David J.; Hollander, Judd E.; Mistry, Rakesh D.; Gavin, Laurence; Tolomeo, Pam; Wise, Jacqueleen; Wheeler, Mary K.; Bilker, Warren B.; Han, Xiaoyan; Hu, Baofeng; Fishman, Neil O.; Lautenbach, Ebbing

doi:10.1093/cid/civ075

Cited by 49 publications

(55 citation statements)

References 36 publications

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“…However, one study conducted in a rehabilitation center estimated the median nasal carriage time to be 44 days, which is not very different from our estimate (7). Moreover, a recent study that collected specimens from patients with MRSA skin and soft tissue infections and their household members for MRSA surveillance cultures every 2 weeks for 6 months reported median MRSA colonization duration of 21 days, a finding which is also close to our findings (31). Pertinently, fluoroquinolone use in the present study was associated with earlier loss of MSSA colonization but not with loss of MRSA colonization.…”

Section: Discussionsupporting

confidence: 91%

Fluoroquinolone Impact on Nasal Methicillin-Resistant and Methicillin-Sensitive Staphylococcus aureus Colonization Durations in Neurologic Long-Term-Care Facilities

Couderc

Thiébaut

Lawrence

et al. 2015

Antimicrob Agents Chemother

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k Staphylococcus aureus nasal carriage is a risk factor for subsequent infection. Estimates of colonization duration vary widely among studies, and factors influencing the time to loss of colonization, especially the impact of antibiotics, remain unclear. We conducted a prospective study on patients naive for S. aureus colonization in 4 French long-term-care facilities. Data on nasal colonization status and potential factors for loss of colonization were collected weekly. We estimated methicillin-resistant S. aureus (MRSA) and methicillin-sensitive S. aureus (MSSA) colonization durations using the Kaplan-Meier method and investigated factors for loss of colonization using shared-frailty Cox proportional hazards models. A total of 285 S. aureus colonization episodes were identified in 149 patients. The median time to loss of MRSA or MSSA colonization was 3 weeks (95% confidence interval, 2 to 8 weeks) or 2 weeks (95% confidence interval, 2 to 3 weeks), respectively. In multivariable analyses, the methicillin resistance phenotype was not associated with S. aureus colonization duration (P ‫؍‬ 0.21); the use of fluoroquinolones (hazard ratio, 3.37; 95% confidence interval, 1.31 to 8.71) and having a wound positive for a nonnasal strain (hazard ratio, 2.17; 95% confidence interval, 1.15 to 4.07) were associated with earlier loss of MSSA colonization, while no factor was associated with loss of MRSA colonization. These results suggest that the methicillin resistance phenotype does not influence the S. aureus colonization duration and that fluoroquinolones are associated with loss of MSSA colonization but not with loss of MRSA colonization.

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Section: Discussionsupporting

confidence: 91%

Fluoroquinolone Impact on Nasal Methicillin-Resistant and Methicillin-Sensitive Staphylococcus aureus Colonization Durations in Neurologic Long-Term-Care Facilities

Couderc

Thiébaut

Lawrence

et al. 2015

Antimicrob Agents Chemother

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“…Cluzet et al recently published a study to evaluate both colonization duration and predictors of clearance of MRSA colonization. They found that treatment of skin and soft tissue infection with clindamycin was associated with earlier clearance of MRSA colonization (136). Although the use of oral agents in decolonization of patients with S. aureus has been evaluated in several studies, the optimal dose and duration of therapy are still unclear, as well as whether combination therapy is preferred over monotherapy.…”

Section: Oral Agentsmentioning

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 events that follow a CA-MRSA infection in a household include an increase in: (i) the risk of infections among other household members [26, 44, 45, 48–51]; (ii) MRSA colonization among other household members [46, 47, 52–57, 59]; and (iii) contamination of environmental surfaces [24, 25, 58]. These reports have described epidemic clones that ‘ping pong’ among family members [26, 51], resulting in high rates of recurrent infection.…”

Section: Staphylococcus Aureus Transmission and Disease Within The Homentioning

confidence: 99%

Staphylococcus aureus infections: transmission within households and the community

Knox¹,

Uhlemann²,

Lowy³

2015

Trends in Microbiology

120

103

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Staphylococcus aureus , both methicillin susceptible and resistant, are now major community-based pathogens worldwide. The basis for this is multifactorial and includes the emergence of epidemic clones with enhanced virulence, antibiotic resistance, colonization potential, or transmissibility. Household reservoirs of these unique strains are crucial to their success as community-based pathogens. Staphylococci become resident in households, either as colonizers or environmental contaminants, increasing the risk for recurrent infections. Interactions of household members with others in different households or at community sites including schools and daycare facilities play a critical role in the ability of these strains to become endemic. Colonization density at these sites appears to play an important role in facilitating transmission. The integration of research tools including whole genome sequencing, mathematical modeling and social network analysis have provided additional insight into the transmission dynamics of these strains. Thus far, interventions designed to reduce recurrent infections among household members have had limited success, likely due to the multiplicity of potential sources for recolonization. The development of better strategies to reduce the number of household-based infections will depend on greater insight into the different factors that contribute to the success of these uniquely successful epidemic clones of S. aureus.

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Duration of Colonization and Determinants of Earlier Clearance of Colonization With Methicillin-Resistant Staphylococcus aureus

Cited by 49 publications

References 36 publications

Fluoroquinolone Impact on Nasal Methicillin-Resistant and Methicillin-Sensitive Staphylococcus aureus Colonization Durations in Neurologic Long-Term-Care Facilities

Fluoroquinolone Impact on Nasal Methicillin-Resistant and Methicillin-Sensitive Staphylococcus aureus Colonization Durations in Neurologic Long-Term-Care Facilities

Decolonization in Prevention of Health Care-Associated Infections

Staphylococcus aureus infections: transmission within households and the community

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