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2015 ; 4
(ä): 56
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Efficacy of the decolonization of methicillin-resistant Staphylococcus aureus
carriers in clinical practice
#MMPMID26688720
Sai N
; Laurent C
; Strale H
; Denis O
; Byl B
Antimicrob Resist Infect Control
2015[]; 4
(ä): 56
PMID26688720
show ga
BACKGROUND: Nasal and extra nasal carriage of methicillin-resistant S. aureus
(MRSA) is a pre-existing condition that often leads to invasive MRSA infection,
as MRSA colonization is associated with a high risk of acquiring MRSA infection
during hospital stays. Decolonization may reduce the risk of meticillin-resistant
Staphylococcus aureus (MRSA) infection in individual carriers and prevent
transmission to other patients. METHODS: A retrospective cohort study was
conducted to evaluate the effectiveness of two decolonization protocols for newly
diagnosed MRSA carriage in hospitalized patients and to assess the impact of
decolonization on the rate of MRSA infection. The study population consisted of
all patients diagnosed as MRSA-positive between January 2006 and June 2010.
Patients diagnosed as carriers were designated as requiring contact precautions
by the hospital infection control team. The standing order protocol of the
hospital pertaining to decolonization procedures was then applied, and all newly
diagnosed patients were administered one of the two decolonization treatments
outlined in the hospital protocol, with the exception of MRSA respiratory
carriers (MRSA obtained from sputum or other lower respiratory tract samples).
The two decolonization treatments consisted of the application of intranasal
mupirocin 2 % and washing with chlorhexidine soap (40 mg/mL) (mupi/CHX) or
application of intranasal povidone-iodine and washing with povidone-iodine soap
(PVPI), with each treatment lasting for 5 days. Success was determined by at
least three successive nose swabs and throat and other screened site swabs that
tested negative for MRSA before patient discharge. RESULTS: A total of 1150
patients admitted to the hospital were found to be infected or colonized with
MRSA. Of the 1150 patients, 268 were prescribed decolonization treatment. 104 out
of 268 patients (39 %) were successfully decolonized. There was no significant
success after two decolonization failures. MRSA infection rate among the
successes and failures were 0.0 and 4.3 %, respectively [P?=?0.04]. CONCLUSIONS:
Our results fit well with the prescription of decolonization based on local
strategy protocols but reflect a low rate of successful treatment. Although the
success rate of decolonization was not high in our study, the effectiveness of
decolonization on the infection rate, justifies the continuation of this
strategy, even if a marginal cost is incurred.