Meticillin-resistant Staphylococcus aureus control in an intensive care unit: a 10 year analysis

Raineri, Enrico; Crema, Luciano; Silvestri, Annalisa De; Acquarolo, Annamaria; Albertario, F; Carnevale, G; Latronico, Nicola; Petrosillo, Nicola; Tinelli, Carmine; Zoncada, Alessia; Pan, Angelo

doi:10.1016/j.jhin.2007.08.013

Cited by 35 publications

(29 citation statements)

References 31 publications

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“…A reduction in antibiotic use can reduce the emergence of resistance during antibiotic therapy but may be of less importance in outbreaks of epidemic clones of MRSA and ESBL phenotype of K. pneumoniae. The "search and destroy" strategy including MRSA screening at admission has been advocated and used successfully to control MRSA in many settings [23][24][25][26]. However, Harbarth et al [27] recently found that rapid MRSA screening at admission plus standard infection control measures versus standard infection control alone did not reduce nosocomial MRSA infection in a surgical department.…”

Section: Discussionmentioning

confidence: 99%

Surveillance of microbial resistance in European Intensive Care Units: a first report from the Care-ICU programme for improved infection control

et al. 2008

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Purpose To report initial results from a European ICU surveillance programme focussing on antibiotic consumption, microbial resistance and infection control. Methods Thirty-five ICUs participated during 2005. Microbial resistance, antibiotic consumption and infection control stewardship measures were entered locally into a webapplication. Results were validated locally, aggregated by project leaders and fed back to support local audit and benchmarking. Results Median (range) antibiotic consumption was 1,254 (range 348-4,992) DDD per 1,000 occupied bed days. The proportion of MRSA was median 11.6% (range 0-100), for ESBL phenotype of E. coli and K. pneumoniae 3.9% (0-80) and 14.3% (0-77.8) respectively, and for carbapenem-resistant P. aeruginosa 22.5% (0-100). Screening on admission for alert pathogens was commonly omitted, and there was a lack of single rooms for isolation. Conclusions The surveillance programme demonstrated wide variation in antibiotic consumption, microbial resistance and infection control measures. The programme may, by providing rapid access to aggregated results, promote local and regional audit and benchmarking of antibiotic use and infection control practices.

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Section: Discussionmentioning

confidence: 99%

Surveillance of microbial resistance in European Intensive Care Units: a first report from the Care-ICU programme for improved infection control

et al. 2008

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“…I den ene studien ble forekomsten av MRSA redusert når pasienter med MRSA ble isolert på enerom eller kohortisolert fremfor å ikke bli isolert (7). Den andre studien viste ingen økt spredning av MRSA på intensivavdelingene etter at man sluttet å isolere pasienter med MRSA (9).…”

Section: Resultater I øVrige Inkluderte Artiklerunclassified

“…7 Flere miljøer enn de nevnte kan ha økt forekomst av MRSA. MRSA-prøve tas dersom det fremkommer opplysninger om at pasienten har oppholdt seg i et miljø der det er økt risiko for å bli smittet med MRSA.…”

Section: Tiltak I Sykehusunclassified

Are measures against MRSA transmission effective?

Haug¹

2018

Tidsskriftet

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“…Three studies compared a combination of mupirocin and chlorhexidine gluconate (CHG) with SOC [38][39][40], 1 study compared the mupirocin-CHG combination with active surveillance [41], and 1 study compared the mupirocin-CHG combination with CHG and povidone iodine (PI) [42]. Four studies compared a combination of mupirocin and other interventions such as CHG, PI, contact precautions, or hygiene retraining-1 with SOC [43], 2 with PI [44,45], and 1 with PI and hygiene retraining [46].…”

Section: Study Characteristicsmentioning

confidence: 99%

Clinical Effectiveness of Mupirocin for PreventingStaphylococcus aureusInfections in Nonsurgical Settings: A Meta-analysis

et al. 2015

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A systematic literature review and meta-analysis was performed to identify effectiveness of mupirocin decolonization in prevention of Staphylococcus aureus infections, among nonsurgical settings. Of the 15 662 unique studies identified up to August 2015, 13 randomized controlled trials, 22 quasi-experimental studies, and 1 retrospective cohort study met the inclusion criteria. Studies were excluded if mupirocin was not used for decolonization, there was no control group, or the study was conducted in an outbreak setting. The crude risk ratios were pooled (cpRR) using a random-effects model. We observed substantial heterogeneity among included studies (I 2 = 80%). Mupirocin was observed to reduce the risk for S. aureus infections by 59% (cpRR, 0.41; 95% confidence interval [CI], .36-.48) and 40% (cpRR, 0.60; 95% CI, .46-.79) in both dialysis and nondialysis settings, respectively. Mupirocin decolonization was protective against S. aureus infections among both dialysis and adult intensive care patients. Future studies are needed in other settings such as long-term care and pediatrics.Keywords. mupirocin; S. aureus; nonsurgical; decolonization; infection.Staphylococcus aureus is a commensal, opportunistic pathogen due to its ability to colonize and increase the likelihood of infection. Staphylococcus aureus is observed to be the most common cause of healthcare-associated infections such as nosocomial bloodstream infection, dialysis-associated infection, and infections occurring in intensive care units (ICUs) [1]. The risk of subsequent infection is observed to be 2-12 times higher in S. aureus nasal carriers compared with noncarriers [2,3]. Staphylococcus aureus infections such as bacteremia and surgical site infections are predominantly caused by endogenous strains in nasal carriers [4][5][6]. Nasal decolonization is often performed in an effort to eradicate the endogenous S. aureus to prevent S. aureus infections. Mupirocin has emerged as the antibacterial of choice for short-term eradication of S. aureus carriage due to its ease of application, low cost, and effectiveness. However, there is concern that overuse of mupirocin could lead to mupirocin resistance (mupR), resulting in failure to prevent S. aureus infections. Resistance to mupirocin was observed to be relatively rare in short-term use such as in response to an outbreak [7]. In contrast, sustained use of mupirocin-based decolonization regimens among general inpatients, particularly for prolonged periods such as in dialysis patients and use in skin and soft tissue lesions, has resulted in emergence of resistance [8][9][10][11]. Thus, it is important to determine which patient populations can benefit the most from mupirocin decolonization in order to direct use to those populations and prevent overuse.We systematically reviewed all studies that assessed the effectiveness of both nasal and extranasal mupirocin decolonization for prevention of S. aureus infections in nonsurgical settings, and quantified the effectiveness of mupirocin decolonization by speci...

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Meticillin-resistant Staphylococcus aureus control in an intensive care unit: a 10 year analysis

Cited by 35 publications

References 31 publications

Surveillance of microbial resistance in European Intensive Care Units: a first report from the Care-ICU programme for improved infection control

Surveillance of microbial resistance in European Intensive Care Units: a first report from the Care-ICU programme for improved infection control

Are measures against MRSA transmission effective?

Clinical Effectiveness of Mupirocin for PreventingStaphylococcus aureusInfections in Nonsurgical Settings: A Meta-analysis

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