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2016 ; 29
(2
): 201-22
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Decolonization in Prevention of Health Care-Associated Infections
#MMPMID26817630
Septimus EJ
; Schweizer ML
Clin Microbiol Rev
2016[Apr]; 29
(2
): 201-22
PMID26817630
show ga
Colonization with health care-associated pathogens such as Staphylococcus aureus,
enterococci, Gram-negative organisms, and Clostridium difficile is associated
with increased risk of infection. Decolonization is an evidence-based
intervention that can be used to prevent health care-associated infections
(HAIs). This review evaluates agents used for nasal topical decolonization,
topical (e.g., skin) decolonization, oral decolonization, and selective digestive
or oropharyngeal decontamination. Although the majority of studies performed to
date have focused on S. aureus decolonization, there is increasing interest in
how to apply decolonization strategies to reduce infections due to Gram-negative
organisms, especially those that are multidrug resistant. Nasal topical
decolonization agents reviewed include mupirocin, bacitracin, retapamulin,
povidone-iodine, alcohol-based nasal antiseptic, tea tree oil, photodynamic
therapy, omiganan pentahydrochloride, and lysostaphin. Mupirocin is still the
gold standard agent for S. aureus nasal decolonization, but there is concern
about mupirocin resistance, and alternative agents are needed. Of the other nasal
decolonization agents, large clinical trials are still needed to evaluate the
effectiveness of retapamulin, povidone-iodine, alcohol-based nasal antiseptic,
tea tree oil, omiganan pentahydrochloride, and lysostaphin. Given inferior
outcomes and increased risk of allergic dermatitis, the use of
bacitracin-containing compounds cannot be recommended as a decolonization
strategy. Topical decolonization agents reviewed included chlorhexidine gluconate
(CHG), hexachlorophane, povidone-iodine, triclosan, and sodium hypochlorite. Of
these, CHG is the skin decolonization agent that has the strongest evidence base,
and sodium hypochlorite can also be recommended. CHG is associated with
prevention of infections due to Gram-positive and Gram-negative organisms as well
as Candida. Conversely, triclosan use is discouraged, and topical decolonization
with hexachlorophane and povidone-iodine cannot be recommended at this time.
There is also evidence to support use of selective digestive decontamination and
selective oropharyngeal decontamination, but additional studies are needed to
assess resistance to these agents, especially selection for resistance among
Gram-negative organisms. The strongest evidence for decolonization is for use
among surgical patients as a strategy to prevent surgical site infections.
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