Effectiveness and safety of enteral vancomycin to control endemicity of methicillin-resistant Staphylococcus aureus in a medical/surgical intensive care unit

Cal, Miguel A. de la; Cerdá, Enrique; Saene, H. K. F. van; García-Hierro, P.; Negro, E; Parra, Mónica León; Arias, Sara; Ballesteros, Daniel

doi:10.1016/j.jhin.2003.09.021

Cited by 115 publications

(77 citation statements)

References 31 publications

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“…Culturing of wounds or skin lesions in addition to the anterior nares increases the likelihood of detecting MRSA colonization (31,38). Although the anterior nares are understandably considered the best single body site from which to take specimens for culture to screen patients for unrecognized MRSA colonization, rectal or gastrointestinal carriage occurs in a substantial proportion of patients with MRSA nasal colonization (4,5,10,29,40). We decided to conduct MRSA surveillance by screening stool specimens submitted to the laboratory for C. difficile toxin A/B assays for several reasons.…”

Section: Discussionmentioning

confidence: 99%

Frequency and Possible Infection Control Implications of Gastrointestinal Colonization with Methicillin-Resistant Staphylococcus aureus

2005

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Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of health care-associated infections. Multiple factors, including transmission from unrecognized reservoirs of MRSA, are responsible for failure to control the spread of MRSA. We conducted prospective surveillance to determine the frequency of gastrointestinal colonization with MRSA among patients and its possible impact on nosocomial transmission of MRSA. Stool specimens submitted for Clostridium difficile toxin A/B assays were routinely inoculated on colistinnaladixic acid agar plates, and S. aureus was identified by using standard methods. Methicillin resistance was confirmed by growth on oxacillin-salt screening agar. For patients whose stool yielded MRSA, information regarding any previous cultures positive for MRSA or other organisms that would require contact precautions was obtained from the laboratory's computer system. During a 1-year period, 151 (9.8%) of 1,543 patients who had one or more stool specimens screened had MRSA in their stool. Ninety-three ( Screening of patients at high risk of colonization by methicillin-resistant Staphylococcus aureus (MRSA) has been recommended as a measure for controlling transmission of the organism in health care settings (24). Culture of specimens from the anterior nares and other body sites, such as wounds from high-risk individuals, often identifies patients with unrecognized MRSA colonization (9,12,19,38). Although gastrointestinal tract colonization by MRSA has been reported previously (4, 10, 29), culturing the stool specimens of patients who have been hospitalized for more than 3 days for potential pathogens is generally not recommended (33, 39). We conducted prospective surveillance of stool specimens in a hospital where MRSA is highly endemic to determine the frequency of MRSA gastrointestinal colonization among high-risk patients. A secondary aim of the study was to determine if recognition of gastrointestinal colonization by MRSA would affect the implementation of barrier precautions designed to reduce the spread of MRSA. MATERIALS AND METHODSAs part of ongoing surveillance for MRSA in a 450-bed university-affiliated teaching hospital, all stool specimens submitted to the clinical microbiology laboratory for Clostridium difficile toxin A/B testing were inoculated onto colistinnaladixic acid (CNA) agar plates that were incubated under aerobic conditions at 36°C overnight. This approach was taken because it seemed likely that patients at risk of antibiotic-associated diarrhea due to C. difficile would also be at increased risk of carrying other resistant pathogens such as MRSA. Colonies growing on CNA agar with morphology characteristic of S. aureus were identified by using coagulase tests. Those identified as S. aureus were inoculated onto commercially available oxacillin-salt screening agar (BBL, Cockeysville, MD), and those capable of growing on oxacillin-salt screening agar were classified as MRSA. The number of colonies of MRSA growing on CNA plates was recorded as 1ϩ to 4ϩ, with 4ϩ re...

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Section: Discussionmentioning

confidence: 99%

Frequency and Possible Infection Control Implications of Gastrointestinal Colonization with Methicillin-Resistant Staphylococcus aureus

2005

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“…More novel treatment modalities for intestinal MRSA elimination to control transmission or subsequent infections, e.g., using oral vancomycin, have been described merely in uncontrolled or observational studies. Oral vancomycin treatment results were reported that showed that the eradication of MRSA intestinal carriage by enteral vancomycin in subsets of adult ICU patients [58][59][60] as well as in pediatric patients [61,62] was effective, but had limited effect on the prevention of transmission. The results from prospective controlled studies of intestinal MRSA decolonization are urgently awaited.…”

Section: Eradication Of Intestinal Carriagementioning

confidence: 99%

Intestinal carriage of Staphylococcus aureus: how does its frequency compare with that of nasal carriage and what is its clinical impact?

Acton¹,

Plat-Sinnige

Wamel

et al. 2008

Eur J Clin Microbiol Infect Dis

214

162

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The bacterial species Staphylococcus aureus, including its methicillin-resistant variant (MRSA), finds its primary ecological niche in the human nose, but is also able to colonize the intestines and the perineal region. Intestinal carriage has not been widely investigated despite its potential clinical impact. This review summarizes literature on the topic and sketches the current state of affairs from a microbiological and infectious diseases' perspective. Major findings are that the average reported detection rate of intestinal carriage in healthy individuals and patients is 20% for S. aureus and 9% for MRSA, which is approximately half of that for nasal carriage. Nasal carriage seems to predispose to intestinal carriage, but sole intestinal carriage occurs relatively frequently and is observed in 1 out of 3 intestinal carriers, which provides a rationale to include intestinal screening for surveillance or in outbreak settings. Colonization of the intestinal tract with S. aureus at a young age occurs at a high frequency and may affect the host's immune system. The frequency of intestinal carriage is generally underestimated and may significantly contribute to bacterial dissemination and subsequent risk of infections. Whether intestinal rather than nasal S. aureus carriage is a primary predictor for infections is still ill-defined.

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“…Two recent randomized controlled trials demonstrated that SDD does not increase resistance but actually reduces antibiotic resistance [4,5]. Moreover five long-term SDD observational studies monitored antimicrobial resistance between 2 and 7 years, and reported that bacterial resistance associated with SDD was not a clinical problem [7][8][9][10][11]. These studies have some potential weaknesses: one study was a retrospective case-control study, two studies assessed the percentage of antibiotic-resistant isolates instead of the incidence of patients who acquired antibiotic-resistant bacteria (ARB) [9,10], two studies specifically estimate the efficacy and safety of enteral vancomycin to eradicate oxacillin-resistant Staphylococcus aureus (ORSA) [7,8].…”

Section: Introductionmentioning

confidence: 99%

Long-term use of selective decontamination of the digestive tract does not increase antibiotic resistance: a 5-year prospective cohort study

et al. 2011

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Effectiveness and safety of enteral vancomycin to control endemicity of methicillin-resistant Staphylococcus aureus in a medical/surgical intensive care unit

Cited by 115 publications

References 31 publications

Frequency and Possible Infection Control Implications of Gastrointestinal Colonization with Methicillin-Resistant Staphylococcus aureus

Frequency and Possible Infection Control Implications of Gastrointestinal Colonization with Methicillin-Resistant Staphylococcus aureus

Intestinal carriage of Staphylococcus aureus: how does its frequency compare with that of nasal carriage and what is its clinical impact?

Long-term use of selective decontamination of the digestive tract does not increase antibiotic resistance: a 5-year prospective cohort study

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