Prevention of Nosocomial Infection in Cardiac Surgery by Decontamination of the Nasopharynx and Oropharynx With Chlorhexidine Gluconate

Segers, Patrique; Speekenbrink, Ron G.H.; Ubbink, Dirk T.; Ogtrop, M L van; Mol, Bas A.J.M. de

doi:10.1001/jama.296.20.2460

Cited by 319 publications

(233 citation statements)

References 34 publications

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“…The median time to onset of S. aureus SSI after surgery was 19 days (IQR, [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28], whereas the time to onset of S. aureus BSI was 18 days (IQR, 10-44).…”

Section: Overall Study Populationmentioning

confidence: 99%

Variation in the Type and Frequency of Postoperative Invasive Staphylococcus aureus Infections According to Type of Surgical Procedure

Anderson

Arduino

Reed

et al. 2010

Infect. Control Hosp. Epidemiol.

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Objective.To determine the epidemiological characteristics of postoperative invasive Staphylococcus aureus infection following 4 types of major surgical procedures.Design.Retrospective cohort study.Setting.Eleven hospitals (9 community hospitals and 2 tertiary care hospitals) in North Carolina and Virginia.Patients.Adults undergoing orthopedic, neurosurgical, cardiothoracic, and plastic surgical procedures.Methods.We used previously validated, prospectively collected surgical surveillance data for surgical site infection and microbiological data for bloodstream infection. The study period was 2003 through 2006. We defined invasive S. aureus infection as either nonsuperficial incisional surgical site infection or bloodstream infection. Nonparametric bootstrapping was used to generate 95% confidence intervals (CIs). P values were generated using the Pearson x2 test, Student t test, or Wilcoxon rank-sum test, as appropriate.Results.In total, 81,267 patients underwent 96,455 procedures during the study period. The overall incidence of invasive S. aureus infection was 0.47 infections per 100 procedures (95% CI, 0.43–0.52); 227 (51%) of 446 infections were due to methicillin-resistant S. aureus. Invasive S. aureus infection was more common after cardiothoracic procedures (incidence, 0.79 infections per 100 procedures [95% CI, 0.62–0.97]) than after orthopedic procedures (0.37 infections per 100 procedures [95% CI, 0.32–0.42]), neurosurgical procedures (0.62 infections per 100 procedures [95% CI, 0.53–0.72]), or plastic surgical procedures (0.32 infections per 100 procedures [95% CI, 0.17¬0.47]) (P < .001). Similarly, S. aureus bloodstream infection was most common after cardiothoracic procedures (incidence, 0.57 infections per 100 procedures [95% CI, 0.43–0.72]; P < .001, compared with other procedure types), comprising almost three-quarters of the invasive S. aureus infections after these procedures. The highest rate of surgical site infection was observed after neurosurgical procedures (incidence, 0.50 infections per 100 procedures [95% CI, 0.42–0.59]; P < .001, compared with other procedure types), comprising 80% of invasive S. aureus infections after these procedures.Conclusion.The frequency and type of postoperative invasive S. aureus infection varied significantly across procedure types. The highest risk procedures, such as cardiothoracic procedures, should be targeted for ongoing preventative interventions.

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Section: Overall Study Populationmentioning

confidence: 99%

Variation in the Type and Frequency of Postoperative Invasive Staphylococcus aureus Infections According to Type of Surgical Procedure

Anderson

Arduino

Reed

et al. 2010

Infect. Control Hosp. Epidemiol.

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“…Chlorhexidine at varying concentrations, however, has been evaluated in more than 11 trials. Impacts on VAP rates have been variable: three reported decreases [64][65][66] while the other eight did not [67][68][69][70][71][72][73][74]. One trial reported a decrease in antibiotic usage for patients treated with chlorhexidine [67].…”

Section: Oral Antiseptics and Antibioticsmentioning

confidence: 99%

“…Impacts on other outcomes, however, have been more uniformly disappointing. One trial did report a decrease in mortality [67] and one reported a decrease in duration of hospitalization [66], but these findings were not borne out by the other nine studies. A meta-ana lysis including the six trials published through 2007 suggested a net 44% decrease in VAP rates but no decreases in patients' ventilator days, hospital days or mortality [75].…”

Section: Oral Antiseptics and Antibioticsmentioning

confidence: 99%

Prevention of ventilator-associated pneumonia

Klompas¹

2010

Expert Review of Anti-infective Therapy

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“…[10][11][12][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]33 Nasal mupirocin is considered the best topical agent for the eradication of gram-positive bacteria immediately following the treatment, when the adherence to this protocol is high. 35 As shown in chart 1, 68.8% of the studies that used topical mupirocin for patient decolonization achieved an effective outcome.…”

Section: Discussionmentioning

confidence: 99%

“…5,37 Nevertheless, studies indicated that when used as an agent for the decolonization of MRSA, despite interrupting its transmission, 10 the effectiveness of chlorhexidine is improved when used with other drugs, such as mupirocin. 26,42 Among the analyzed studies, 90.9% of those that tested chlorhexidine obtained effective outcomes for decolonization, 10,12,[15][16]19,22,24,26,29,31 observing that 72.7% of them used chlorhexidine in combination with other drugs. 12,[15][16]19,22,24,26,31 Octenidine dihydrochloride and povidoneiodine are topical antimicrobial agents, both used for skin cleansing and antisepsis for the purpose of preventing infections.…”

Section: Discussionmentioning

confidence: 99%

Descolonização de portadores de Staphylococcus aureus: indicações, vantagens e limitações

Oliveira

Paula

2012

Texto contexto - enferm.

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ABSTRACT:The objective of this article was to establish the main indications, advantages and limitations of the decolonization of patients with Staphylococcus aureus. An integrative literature review was performed on the LILACS, MEDLINE, Science Direct, SCOPUS and Isi Web of Knowledge databases for articles published after 1999. The main indications for decolonization pertained to high-risk patients (admitted to the ICU, post-operative, long stay, etcetera). The advantages were based on the eradication of the microorganism, reducing infection rates and the spread of the microorganism. The observed controversies were due to the possibility of increasing bacterial resistance and lack of scientific evidence regarding the effectiveness of the eradication of the colonizing microorganism, as well as reducing infection rates. Thus, it was observed that decolonization should not be indicated routinely; rather, it should only be recommended for patients at risk and during outbreaks. DESCRIPTORS: Infection control. Methicillin-resistant Staphylococcus aureus. Cross infection. Bacterial drug resistance. DESCOLONIZAÇÃO DE PORTADORES DE STAPHYLOCOCCUS AUREUS:INDICAÇÕES, VANTAGENS E LIMITAÇÕES RESUMO: O objetivo deste artigo foi estabelecer as principais indicações, vantagens e limitações da descolonização de pacientes portadores de Staphylococcus aureus. Procedeu-se a uma revisão integrativa da literatura, com busca de artigos nas bases de dados LILACS, MEDLINE, Science Direct, SCOPUS e Isi Web of Knowledge, e em publicações a partir de 1999. As principais indicações encontradas foram direcionadas aos pacientes considerados de alto risco (admitidos em UTI, submetidos à cirurgia, com longa permanência, etc.). As vantagens fundamentaram-se na erradicação do microrganismo, redução da taxas de infecção e na disseminação destes. As controvérsias se deram pela possibilidade do aumento da resistência bacteriana e pela falta de evidências científicas sobre a eficácia da eliminação do microrganismo colonizante e da redução da taxa de infecção. Observou-se que a descolonização não deve ser indicada como rotina, mas, sim, deve ser recomendada apenas para pacientes de risco e durante surtos. DESCRITORES: Controle de infecções.Staphylococcus aureus resistente à meticilina. Infecção hospitalar. Farmacorresistência bacteriana. DESCOLONIZACIÓN DE PORTADORES DE STAPHYLOCOCCUS AUREUS: INDICACIONES, VENTAJAS Y LIMITACIONES RESUMEN:El objetivo fue establecer las principales indicaciones, ventajas y limitaciones de la descolonización de los pacientes infectados por Staphylococcus aureus. Se realizó una revisión integrativa de literatura, buscando artículos, publicados a partir de 1999, en las bases de datos LILACS, MEDLINE, Science Direct, SCOPUS y el ISI Web of Knowledge. Las principales indicaciones fueron dirigidas a los pacientes de alto riesgo (ingresados en la UCI, sometidos a cirugía, con una estancia de larga duración, etc), los beneficios se fundamentaron en la erradicación y reducción de la propagación de microrganismos y la reducción ...

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Prevention of Nosocomial Infection in Cardiac Surgery by Decontamination of the Nasopharynx and Oropharynx With Chlorhexidine Gluconate

Abstract: clinicaltrials.gov Identifier: NCT00272675.

Cited by 319 publications

References 34 publications

Variation in the Type and Frequency of Postoperative Invasive Staphylococcus aureus Infections According to Type of Surgical Procedure

Variation in the Type and Frequency of Postoperative Invasive Staphylococcus aureus Infections According to Type of Surgical Procedure

Prevention of ventilator-associated pneumonia

Descolonização de portadores de Staphylococcus aureus: indicações, vantagens e limitações

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