Role of targeted and universal mupirocin‑based decolonization for preventing surgical‑site infections in patients undergoing cardiothoracic surgery: A systematic review and meta‑analysis

Wang, Li; Qi, Ji; Hu, Xiaosong

doi:10.3892/etm.2021.9860

Cited by 6 publications

(3 citation statements)

References 51 publications

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“…The 2013 American Society of Health-System Pharmacists Guideline for Antimicrobial Prophylaxis in Surgery recommends screening for S. aureus and to decolonize with mupirocin if patients test positive (Bratzler et al, 2013). Although there are conflicting data to support routine MRSA decolonization, the supporting evidence is the strongest in cardiothoracic and orthopaedic surgical patients (George et al, 2016; Schweizer et al, 2013; Wang et al, 2021). Studies are often limited by observational design, sample size, lack of standard decolonization procedures, or risk of bias.…”

Section: Decolonization With Mupirocinmentioning

confidence: 99%

Overview of Antibiotic Prophylaxis in Orthopaedic and Cardiac Procedures

Karapetyan,

Mei,

Choudhury

et al. 2023

Orthopaedic Nursing

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Antibiotic prophylaxis (AP) in surgical procedures is commonly used to prevent infections that may occur after operations. There are multiple factors that can contribute to increased risk of postsurgical complications that include prolonged hospitalization, reoperation, and readmissions. One of the strategies of decreasing the risk of bacterial contamination and developing infections is preprocedural antibiotic administration. When selecting an appropriate antibiotic, it is important to take into account surgery type and patient's characteristics which would also impact timing of administration and prophylaxis duration. Although surgical AP is significant for avoiding bacterial complications, it is also associated with some drawbacks such as increased antibiotic resistance and development of adverse reactions. Therefore, it is important to assess risks and benefits and select the most appropriate antibiotic regimen before initiating AP.

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Section: Decolonization With Mupirocinmentioning

confidence: 99%

Overview of Antibiotic Prophylaxis in Orthopaedic and Cardiac Procedures

Karapetyan,

Mei,

Choudhury

et al. 2023

Orthopaedic Nursing

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“…This most likely resulted from the heterogeneity of the groups in included studies. In turn, a recent systematic review and meta-analysis based on 17 studies, including a total of over 26,000 post-sternotomy patients, revealed a significant SSI reduction in a group undergoing decolonisation [ 98 ]. Despite partially contradictory results of studies regarding the effectiveness of S. aureus eradication in SSI prevention, most scientific societies clearly recommend this procedure [ 7 , 8 , 26 , 66 , 83 , 99 ].…”

Section: Ssi Preventionmentioning

confidence: 99%

Surgical Site Infection in Cardiac Surgery

Żukowska¹,

Żukowski

2022

JCM

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Surgical site infections (SSIs) are one of the most significant complications in surgical patients and are strongly associated with poorer prognosis. Due to their aggressive character, cardiac surgical procedures carry a particular high risk of postoperative infection, with infection incidence rates ranging from a reported 3.5% and 26.8% in cardiac surgery patients. Given the specific nature of cardiac surgical procedures, sternal wound and graft harvesting site infections are the most common SSIs. Undoubtedly, DSWIs, including mediastinitis, in cardiac surgery patients remain a significant clinical problem as they are associated with increased hospital stay, substantial medical costs and high mortality, ranging from 3% to 20%. In SSI prevention, it is important to implement procedures reducing preoperative risk factors, such as: obesity, hypoalbuminemia, abnormal glucose levels, smoking and S. aureus carriage. For decolonisation of S. aureus carriers prior to cardiac surgery, it is recommended to administer nasal mupirocin, together with baths using chlorhexidine-based agents. Perioperative management also involves antibiotic prophylaxis, surgical site preparation, topical antibiotic administration and the maintenance of normal glucose levels. SSI treatment involves surgical intervention, NPWT application and antibiotic therapy

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“…Using chlorhexidine gluconate to cleanse the mouth, nose, and body can decrease total NI content by one fourth (10), and preoperative chlorhexidine mouthwash has been found to nearly halve the risk of postoperative pneumonia (12). Intranasal mupirocin treatment is effective in lessening SA carriage and the total incidence of SSI, but the evidence remains controversial for MRSA-related SSI (13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

Effects of preoperative Staphylococcus aureus screening and targeted decolonization bundle protocols in cardiac surgery: a nine-year review of a regional cardiovascular center in China

Sun¹,

Qian²,

Zhang³

et al. 2022

J Thorac Dis

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Background: Nosocomial infection (NI) prolongs hospital stay and heightens mortality among patients who underwent cardiac surgery. We constructed a retrospective study to explore the prevalence of Staphylococcus aureus and methicillin-resistant Staphylococcus aureus (SA/MRSA) nasal colonization, as well as the effects of SA/MRSA decolonization bundle measures on SA/MRSA-related infection among Chinese cardiac patients. Methods: After reviewing the medical records, we divided cardiovascular surgery patients treated at our central campus into two groups: the baseline group (treated between January 2012 and December 2013) and the intervention group (treated between May 2014 and December 2020). Intervention measures consisted of preoperative nasal screening and targeted decolonization bundle therapy. The medical records of patients at our southern campus (treated between January 2017 and December 2020) were collected as an additional control group, since we did not implement SA intervention measures at this location. The incidences of SA/ MRSA-related NI were then compared between the groups.Results: There were 794 patients in the baseline group and 2,826 in the intervention group. A total of 131 (4.6%) patients had SA nasal colonization, and among them, 33 patients (1.2%) were MRSA colonized. SA/MRSA was cleared in approximately 95% of the carriers. The total level of SA-related infection was significantly lower in the intervention group compared to the baseline group [0.354% vs. 1.133%, respectively; P=0.021; risk ratio (RR): 0.312; 95% confidence interval (CI): 0.127-0.766]. The incidence of MRSA-related infection followed the same trend (0.212% vs. 0.756%, respectively; P=0.030; RR: 0.281; 95% CI: 0.091-0.860). When compared to the southern campus, SA intervention measures at the central campus resulted in a significant reduction in total SA-related infection (1.132% vs. 0.284%, respectively; P=0.035; RR: 0.251; 95% CI: 0.077-0.820). Conclusions:The prevalence of SA/MRSA colonization is relatively low among Chinese patients who received cardiovascular surgery. Targeted decolonization bundle therapy was associated with cleared colonization and reduced incidence of SA/MRSA-related infection.

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Role of targeted and universal mupirocin‑based decolonization for preventing surgical‑site infections in patients undergoing cardiothoracic surgery: A systematic review and meta‑analysis

Cited by 6 publications

References 51 publications

Overview of Antibiotic Prophylaxis in Orthopaedic and Cardiac Procedures

Overview of Antibiotic Prophylaxis in Orthopaedic and Cardiac Procedures

Surgical Site Infection in Cardiac Surgery

Effects of preoperative Staphylococcus aureus screening and targeted decolonization bundle protocols in cardiac surgery: a nine-year review of a regional cardiovascular center in China

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