Successful decolonization of meticillin-resistant Staphylococcus aureus in paediatric patients with cystic fibrosis (CF) using a three-step protocol

MacFarlane, Mary; Leavy, A.; McCaughan, J.; Fair, Richard J.; Reid, A.

doi:10.1016/j.jhin.2006.10.011

Cited by 54 publications

(53 citation statements)

References 10 publications

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“…First, several other trials evaluated the efficacy of MRSA decol- 24 In pediatric patients with cystic fibrosis, a 3-step protocol with topical mupirocin, chlorhexidine for washing, and a 5-day course of rifampin and fusidic acid has been evaluated; MRSA eradication was achieved in 16 (94%) of 17 patients-8 (47%) after 1 decolonization course and 8 (47%) after 2 or 3 decolonization courses. 25 Maraha et al 26 found the rate of MRSA elimination to be 100% after a mean of 1.6 courses of treatment with enteral vancomycin and topical antimicrobials during an outbreak; decolonization was achieved after 1 course in 69% of patients.…”

Section: Discussionmentioning

confidence: 99%

Highly Effective Regimen for Decolonization of Methicillin-ResistantStaphylococcus aureusCarriers

Buehlmann

Frei

Fenner

et al. 2008

Infect. Control Hosp. Epidemiol.

131

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OBJECTIVE. To evaluate the efficacy of a standardized regimen for decolonization of methicillin-resistant Staphylococcus aureus (MRSA) carriers and to identify factors influencing decolonization treatment failure. SETTING. University hospital with 750 beds and 27,000 admissions/year. PATIENTS. Of 94 consecutive hospitalized patients with MRSA colonization or infection, 32 were excluded because of spontaneous loss of MRSA, contraindications, death, or refusal to participate. In 62 patients, decolonization treatment was completed. At least 6 body sites were screened for MRSA (including by use of rectal swabs) before the start of treatment.INTERVENTIONS. Standardized decolonization treatment consisted of mupirocin nasal ointment, chlorhexidine mouth rinse, and full-body wash with chlorhexidine soap for 5 days. Intestinal and urinary-tract colonization were treated with oral vancomycin and cotrimoxazole, respectively. Vaginal colonization was treated with povidone-iodine or, alternatively, with chlorhexidine ovula or octenidine solution. Other antibiotics were added to the regimen if treatment failed. Successful decolonization was considered to have been achieved if results were negative for 3 consecutive sets of cultures of more than 6 screening sites. ). Decolonization was completed in 87% of patients after a mean (±SD) of 2.1 ± 1.8 decolonization cycles (range, 1-10 cycles). Sixty-five percent of patients ultimately required peroral antibiotic treatment (vancomycin, 52%; cotrimoxazole, 27%; rifampin and fusidic acid, 18%). Decolonization was successful in 54 (87%) of the patients in the intent-to-treat analysis and in 51 (98%) of 52 patients in the on-treatment analysis.CONCLUSION. This standardized regimen for MRSA decolonization was highly effective in patients who completed the full decolonization treatment course. 2008; 29:510-516 In past decades, methicillin-resistant Staphylococcus aureus and outbreaks among injection drug abusers, prisoners, homeless (MRSA) has become the most important multidrug-resistant individuals, sports teams, and children in day care centers. 5,6 pathogen worldwide, causing significant morbidity and increased Studies of surgical patients colonized with methicillinhealthcare costs. Infect Control Hosp Epidemiol1,2 MRSA colonization precedes MRSA infection, susceptible S. aureus have demonstrated that decolonization which occurs in 20%-60% of colonized patients in acute-care treatment-for example, with mupirocin-can reduce the infacilities and in 3%-15% of those in long-term-care facilities. 3 The cidence of subsequent infection. 7 In addition, most authorities rate of nosocomial transmission of MRSA in healthcare facilities recommend that MRSA carriers be decolonized in outbreak can be reduced by the use of strict infection-control measures, situations. such as establishment of MRSA surveillance; early identification MRSA decolonization may reduce the risk of MRSA infecof carriers; isolation of colonized or infected patients; use of bartion in individual carriers and could prevent...

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Section: Discussionmentioning

confidence: 99%

Highly Effective Regimen for Decolonization of Methicillin-ResistantStaphylococcus aureusCarriers

Buehlmann

Frei

Fenner

et al. 2008

Infect. Control Hosp. Epidemiol.

131

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“…All CF patients in Northern Ireland are tested every 3 months for MRSA colonization; 17/250 were found to carry MRSA at some time during 1999 to 2004. By using a three-step protocol requiring 1 or 2 courses of oral fusidic acid and rifampin followed, if necessary, by intravenous teicoplanin, investigators were able to decolonize 16 of the 17 CF patients; they all remained free of MRSA sputum colonization 1 year later (567).…”

Section: Cystic Fibrosismentioning

confidence: 99%

Community-Associated Methicillin-ResistantStaphylococcus aureus: Epidemiology and Clinical Consequences of an Emerging Epidemic

2010

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SUMMARY Staphylococcus aureus is an important cause of skin and soft-tissue infections (SSTIs), endovascular infections, pneumonia, septic arthritis, endocarditis, osteomyelitis, foreign-body infections, and sepsis. Methicillin-resistant S. aureus (MRSA) isolates were once confined largely to hospitals, other health care environments, and patients frequenting these facilities. Since the mid-1990s, however, there has been an explosion in the number of MRSA infections reported in populations lacking risk factors for exposure to the health care system. This increase in the incidence of MRSA infection has been associated with the recognition of new MRSA clones known as community-associated MRSA (CA-MRSA). CA-MRSA strains differ from the older, health care-associated MRSA strains; they infect a different group of patients, they cause different clinical syndromes, they differ in antimicrobial susceptibility patterns, they spread rapidly among healthy people in the community, and they frequently cause infections in health care environments as well. This review details what is known about the epidemiology of CA-MRSA strains and the clinical spectrum of infectious syndromes associated with them that ranges from a commensal state to severe, overwhelming infection. It also addresses the therapy of these infections and strategies for their prevention.

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“…Eradication protocols have been tested in a small number of CF patients. A step-wise eradication protocol has been developed in CF centers in Belfast [65]. In a non-controlled study of 17 pediatric subjects, MRSA was successfully eradicated in 94% of the subjects using a 3 stepprotocol.…”

Section: Eradication Strategies Of Mrsamentioning

confidence: 99%

Review: Staphylococcus aureus and MRSA in cystic fibrosis

Goss

Muhlebach

2011

Journal of Cystic Fibrosis

187

160

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Successful decolonization of meticillin-resistant Staphylococcus aureus in paediatric patients with cystic fibrosis (CF) using a three-step protocol

Cited by 54 publications

References 10 publications

Highly Effective Regimen for Decolonization of Methicillin-ResistantStaphylococcus aureusCarriers

Highly Effective Regimen for Decolonization of Methicillin-ResistantStaphylococcus aureusCarriers

Community-Associated Methicillin-ResistantStaphylococcus aureus: Epidemiology and Clinical Consequences of an Emerging Epidemic

Review: Staphylococcus aureus and MRSA in cystic fibrosis

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