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Highly Effective Regimen for Decolonization of Methicillin-Resistant Staphylococcus aureus Carriers

Published online by Cambridge University Press:  02 January 2015

M. Buehlmann ,
R. Frei ,
L. Fenner ,
M. Dangel ,
U. Fluckiger  and
A. F. Widmer
M. Buehlmann
Affiliation:
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
R. Frei
Affiliation:
Microbiology Laboratory, University Hospital Basel, Basel, Switzerland
L. Fenner
Affiliation:
Microbiology Laboratory, University Hospital Basel, Basel, Switzerland
M. Dangel
Affiliation:
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
U. Fluckiger
Affiliation:
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
A. F. Widmer*
Affiliation:
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
*
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland ([email protected])
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Abstract

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.

Design.

Prospective cohort study from January 2002 to April 2007, with a mean follow-up period of 36 months.

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.

Results.

The mean age (± standard deviation [SD]) age of the 62 patients was 66.2 ± 19 years. The most frequent locations of MRSA colonization were the nose (42 patients [68%]), the throat (33 [53%]), perianal area (33 [53%]), rectum (36 [58%]), and inguinal area (30 [49%]). 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.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 6 , June 2008 , pp. 510 - 516
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

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References

1.Lowy, FD. Staphylococcus aureus infections. N Engl J Med 1998;339:520–532.Google Scholar
2.Gould, IM. The clinical significance of methicillin-resistant Staphylococcus aureus. J Hosp Infect 2005;61:277–282.Google Scholar
3.Rubinovitch, B, Pittet, D. Screening for methicillin-resistant Staphylococcus aureus in the endemic hospital: what have we learned? J Hosp Infect 2001;47:9–18.Google Scholar
4.Pittet, D, Hugonnet, S, Harbarth, S, et al. Effectiveness of a hospital-wide programme to improve compliance of hand-hygiene. Lancet 2000;356:1307–1312.CrossRefGoogle ScholarPubMed
5.Gilbert, M, MacDonald, J, Gregson, D, et al. Outbreak in Alberta of community-acquired (USA300) methicillin-resistant Staphylococcus aureus in people with a history of drug use, homelessness or incarceration. CMAJ 2006;175:149–154.Google Scholar
6.Weber, JT. Community-associated methicillin-resistant Staphylococcus aureus. Clin Infect Dis 2005;41(Suppl 4):S269–272.Google Scholar
7.Perl, TM, Cullen, JJ, Wenzel, RP, et al. Intranasal mupirocin to prevent postoperative Staphylococcus aureus infections. N Engl J Med 2002;346:1871–1877.Google Scholar
8.Loeb, M, Main, C, Walker-Dilks, C, et al. Antimicrobial drugs for treating methicillin-resistant Staphylococcus aureus colonization. Cochrane Database SystRev 2003;(4).Google Scholar
9.Loveday, HP, Pellowe, CM, Jones SRLJ, et al. A systematic review of the evidence for interventions for the prevention and control of methicillin-resistant Staphylococcus aureus (1996–2004): report to the Joint MRSA Working Party (Subgroup A). J Hosp Infect 2006;63:S45–S70.Google Scholar
10.Walsh, TJ, Standiford, HC, Reboli, AC, et al. Randomized double-blinded trial of rifampin with either novobiocin or trimethoprim-sulfamethoxazole against methicillin-resistant Staphylococcus aureus colonization: prevention of antimicrobial resistance and effect of host factors on outcome. Antimicrob Agents Chemother 1993;37:1334–1342.CrossRefGoogle ScholarPubMed
11.Simor, AE, Phillips, E, McGeer, A, et al. Randomized controlled trial of chlorhexidine gluconate for washing, intranasal mupirocin, and rifampin and doxycycline versus no treatment for the eradication of methicillin-resistant Staphylococcus aureus colonization. Clin Infect Dis 2007;44:178–185.Google Scholar
12.Mertz, D, Frei, R, Jaussi, B, et al. Throat swabs are necessary to reliably detect carriers of Staphylococcus aureus. Clin Infect Dis 2007;45:475–477.CrossRefGoogle Scholar
13. In: Mayhall, CG, Horan, TC, Gaynes, RP, eds. Hospital Epidemiology and Infection Control: Surveillance of Nosocomial Infections. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2004:1659–1702.Google Scholar
14.Strandén, AM, Frei, R, Widmer, AF. Molecular typing of methicillin-resistant S. aureus (MRSA): can PCR replace pulsed-field gel electrophoresis. J Clin Microbiol 2003;41:3181–3186.Google Scholar
15.Strommenger, B, Kettlitz, C, Weniger, T, et al. Assignment of Staphylococcus isolates to groups by spa typing, Smal macrorestriction analysis, and multilocus sequence typing. J Clin Microbiol 2006;44:2533–2540.Google Scholar
16.Lina, G, Piemont, Y, Godail-Gamot, F, et al. Involvement of Panton-Valentine leukocidin producing Staphylococcus aureus in primary skin infections and pneumonia. Clin Infect Dis 1999;29:1128–1132.Google Scholar
17.Yamasaki, O, Tristan, A, Yamaguchi, T, et al. Distribution of the exfoliative toxin D gene in clinical Staphylococcus aureus isolates in France. Clin Microbiol Infect 2006;12:585–588.Google Scholar
18.Mehrotra, M, Wang, G, Johnson, WM. Multiplex PCR for detection of genes for Staphylococcus aureus enterotoxins, exfoliative toxins, toxic shock syndrome toxin 1, and methicillin resistance. J Clin Microbiol 2000;38:1032–1035.Google Scholar
19.Murakami, K, Minamide, W, Wada, K, et al. Identification of methicillin-resistant strains of staphylococci by polymerase chain reaction. J Clin Microbiol 1991;29:2240–2244.CrossRefGoogle ScholarPubMed
20.Ridom SpaServer. Available at: http://www.spaserver.ridom.de. Accessed February 20, 2008.Google Scholar
21.MacGowan, AP, Wise, R. Establishing MIC breakpoints and the interpretation of in vitro susceptibility tests. J Antimicrob Chemother 2001;48:17–28.CrossRefGoogle ScholarPubMed
22.Simor, AE, Stuart, TL, Louie, L, et al. Mupirocin-resistant, methicillin-resistant Staphylococcus aureus strains in Canadian hospitals. Antimicrob Agents Chemother 2007;51:3880–3886.Google Scholar
23.Harbarth, S, Dharan, S, Liassine, N, et al. Randomized, placebo-controlled, double-blind trial to evaluate the efficacy of mupirocin for eradicating carriage of methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother 1999;43:1312–1316.Google Scholar
24.Muder, RR. A controlled trial of rifampicin, minocycline and rifampicin plus minocycline for eradication of methicillin-resistant Staphylococcus aureus in long-term care patients. J Antimicrob Chemother 1994;34:189–190.CrossRefGoogle ScholarPubMed
25.Macfarlane, M, Leavy, A, McVaughan, J, et al. Successful decolonization of methicillin-resistant Staphylococcus aureus in paediatric patients with cystic fibrosis using a three-step protocol. J Hosp Infect 2007;65:231–236.CrossRefGoogle ScholarPubMed
26.Maraha, B, Van Halteren, J, Verzijl, JM, et al. Decolonization of methicillin-resistant Staphylococcus aureus using oral vancomcyin and topical mupirocin. Clin Microbiol Infect 2002;8:671–675.Google Scholar
27.Klotz, M, Zimmermann, S, Opper, S, et al. Possible risk for re-colonization with methicillin-resistant Staphylococcus aureus (MRSA) by faecal transmission. Int J Hyg Environ Health 2005;208:401–405.Google Scholar
28.Boyce, JM, Havill, NL, Maria, B. Frequency and possible infection control implications of gastrointestinal colonization with methicillin-resistant Staphylococcus aureus. J Clin Microbiol 2005;43:5992–5995.Google Scholar
29.Silvestri, L, Milanese, M, Oblach, L, et al. Enteral vancomycin to control methicillin-resistant Staphylococcus aureus outbreak in mechanically ventilated patients. Am J Infect Control 2002;30:391–399.Google Scholar
30.Ringberg, H, Petersson, AC, Walder, M, et al. The throat: an important site for MRSA colonization. Scand J Infect Dis 2006;38:888–893.Google Scholar
31.Garzoni, C, Francois, P, Huyghe, A, et al. A global view of Staphylococcus aureus whole genome expression upon internalization in human epithelial cells. BMC Genomics 2007;8:171.Google Scholar
32.Yamaoka, T. The bactericidal effects of anti-MRSA agents with rifampicin and sulfamethoxazole-trimethoprim against intracellular phagocytized MRSA. J Infect Chemother 2007;13:141–146.Google Scholar
33.Filippini, M, Masiero, G, Moschetti, K. Socioeconomic determinants of regional differences in outpatient antibiotic consumption: evidence from Switzerland. Health Policy 2006;78:77–92.Google Scholar