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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 J+Clin+Microbiol
2016 ; 54
(11
): 2735-2742
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Chlorhexidine and Mupirocin Susceptibility of Methicillin-Resistant
Staphylococcus aureus Isolates in the REDUCE-MRSA Trial
#MMPMID27558180
Hayden MK
; Lolans K
; Haffenreffer K
; Avery TR
; Kleinman K
; Li H
; Kaganov RE
; Lankiewicz J
; Moody J
; Septimus E
; Weinstein RA
; Hickok J
; Jernigan J
; Perlin JB
; Platt R
; Huang SS
J Clin Microbiol
2016[Nov]; 54
(11
): 2735-2742
PMID27558180
show ga
Whether targeted or universal decolonization strategies for the control of
methicillin-resistant Staphylococcus aureus (MRSA) select for resistance to
decolonizing agents is unresolved. The REDUCE-MRSA trial (ClinicalTrials
registration no. NCT00980980) provided an opportunity to investigate this
question. REDUCE-MRSA was a 3-arm, cluster-randomized trial of either screening
and isolation without decolonization, targeted decolonization with chlorhexidine
and mupirocin, or universal decolonization without screening to prevent MRSA
infection in intensive-care unit (ICU) patients. Isolates from the baseline and
intervention periods were collected and tested for susceptibility to
chlorhexidine gluconate (CHG) by microtiter dilution; mupirocin susceptibility
was tested by Etest. The presence of the qacA or qacB gene was determined by PCR
and DNA sequence analysis. A total of 3,173 isolates were analyzed; 2 were
nonsusceptible to CHG (MICs, 8 ?g/ml), and 5/814 (0.6%) carried qacA or qacB At
baseline, 7.1% of MRSA isolates expressed low-level mupirocin resistance, and
7.5% expressed high-level mupirocin resistance. In a mixed-effects generalized
logistic regression model, the odds of mupirocin resistance among clinical MRSA
isolates or MRSA isolates acquired in an ICU in intervention versus baseline
periods did not differ across arms, although estimates were imprecise due to
small numbers. Reduced susceptibility to chlorhexidine and carriage of qacA or
qacB were rare among MRSA isolates in the REDUCE-MRSA trial. The odds of
mupirocin resistance were no different in the intervention versus baseline
periods across arms, but the confidence limits were broad, and the results should
be interpreted with caution.
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