New approaches to prevention of staphylococcal infection in surgery

Current Opinion in Infectious Diseases

Volumn 21, Issue 4, 2008, Pages 380-384

  Van Rijen, Miranda M L ^a   Kluytmans, Jan A J W ^a,b  

^a AMPHIA HOSPITAL   (Netherlands)

^b VU UNIVERSITY MEDICAL CENTER   (Netherlands)

Author keywords

Chlorhexidine gluconate; Infection; Mupirocin; Staphylococcus aureus; Surgery

Indexed keywords

CEFAZOLIN; CHLORHEXIDINE GLUCONATE; PLACEBO; PSEUDOMONIC ACID; VANCOMYCIN; ANTIINFECTIVE AGENT; CHLORHEXIDINE; DRUG DERIVATIVE; TOPICAL ANTIINFECTIVE AGENT;

ANTIBIOTIC PROPHYLAXIS; CLINICAL TRIAL; COST CONTROL; COST EFFECTIVENESS ANALYSIS; DISINFECTION; HOSPITAL INFECTION; HUMAN; INFECTION PREVENTION; METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS; METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS INFECTION; PENICILLIN RESISTANCE; PREVALENCE; REVIEW; STAPHYLOCOCCUS AUREUS; SURGICAL INFECTION; TOOTH DISCOLORATION; CHEMOPROPHYLAXIS; CROSS INFECTION; HETEROZYGOTE; PATIENT CARE; STAPHYLOCOCCUS INFECTION;

ANTI-BACTERIAL AGENTS; ANTI-INFECTIVE AGENTS, LOCAL; ANTIBIOTIC PROPHYLAXIS; CARRIER STATE; CHEMOPREVENTION; CHLORHEXIDINE; CROSS INFECTION; HUMANS; MUPIROCIN; PATIENT ISOLATION; STAPHYLOCOCCAL INFECTIONS; SURGICAL WOUND INFECTION; VANCOMYCIN;

EID: 49049096767     PISSN: 09517375     EISSN: 14736527     Source Type: Journal    
DOI: 10.1097/QCO.0b013e328301391d     Document Type: Review

References (12)

1. Kluytmans J, van Belkum A, Verbrugh H. Nasal carriage of Staphylococcus aureus: epidemiology, underlying mechanisms, and associated risks. Clin Microbiol Rev 1997; 10:505-520.
2. Paule SM, Pasquariello AC, Hacek DM, et al. Direct detection of Staphylococcus aureus from adult and neonate nasal swab specimens using real-time polymerase chain reaction. J Mol Diagn 2004; 6:191-196.
3. Munoz P, Hortal J, Giannella M, et al. Nasal carriage of S. aureus increases the risk of surgicalsiteinfection after majorheart surgery. J Hosp Infect 2008; 68:25-31. The independent risk factors for SSI after major heart surgery were shown to be S. aureus nasal carriage, reoperation, and diabetes mellitus.
4. Morange-Saussier V, Giraudeau B, van der Mee N, et al. Nasal carriage of methicillin-resistant Staphylococcus aureus in vascular surgery. Ann Vasc Surg 2006; 20:767-772. They showed that MRSA infection was highly related to MRSA colonization. The risk factors for MRSA carriage in patients admitted to the vascular unit were origin of the patient from another department and from antoher medical facility.
5. Muralidhar B, Anwar SM, Handa AI, et al. Prevalence of MRSA in emergency and elective patients admitted to a vascular surgical unit: implications for antibiotic prophylaxis. Eur J Vasc Endovasc Surg 2006; 32:402-407. A simple decision analysis model suggested that gentamicin should be used as antibiotic prophylaxis when the prevalence of MRSA reaches 10% and vancomycin when the prevalence reaches 50%.
6. Merrer J, Desbouchages L, Serazin V, et al. Comparison of routine prophylaxis with vancomycin or cefazolin for femoral neck fracture surgery: microbiological and clinical outcomes. Infect Control Hosp Epidemiol 2006; 27:1366-1371. Merrer et al. demonstrated that no development of vancomycin resistance was observed after short-term application. They suggest the use of vancomycin as antibiotic prophylaxis in patients at risk for MRSA to prevent MRSA infection.
7. Segers P, Speekenbrink RG, Ubbink DT, et al. Prevention of nosocomial infection in cardiac surgery by decontamination of the nasopharynx and orophyarynx with chlorhexidine gluconate: a randomzed controlled trial. JAMA 2006; 296:2460-2466. This well designed study showed that chlorhexidine gluconate resulted in a reduced overall nosocomial infection rate, but no effect was found on the S. aureus infection rate. Unfortunately, the results for S. aureus nasal carriers were not described separately.
8. Trautmann M, Stecher J, Hemmer W, et al. Intranasal mupirocin prophylaxis in elective surgery. A review of published studies. Chemotherapy 2008; 54:9-16. This review showed that mupirocin prophylaxis did not reduce the S. aureus SSI rate in patients undergoing surgery. In contrast, mupirocin prophylaxis before surgery reduced the SSI rate due to MRSA. The weakness of this study is that non-English papers were excluded.
9. vanRijen MML, Bonten M, Wenzel RP, Kluytmans JAJW. Intranasal mupirocin for reduction of Staphylococcus aureus infections in surgical patients with nasal carriage: a systematic review. J Antimicrob Chemother 2008; 61:254-261. This systematic review describes the importance of screening and treating S. aureus nasal carriers to prevent S. aureus infections after surgery. This is the first study describing the results in carriers only instead of all patients, that is, carriers and noncarriers.
10. Perl TM, Cullen JJ, Wenzel RP, et al. Intranasal mupirocinto prevent postoperative Staphylococcus aureus infections. N Engl J Med 2002; 346:1871-1877.
11. Young LS, Winston LG. Preoperative use of mupirocin for the prevention of healthcare- associated Staphylococcus aureus infections: a cost-effectiveness analysis. Infect Control Hosp Epidemiol 2006; 27:1304-1312. This model-based analysis showed that both screening of all patients and screening and subsequent treatment of carriers were cost-saving and prevented 86 S. aureus infections for every 10 000 patients undergoing surgery.
12. Noskin GA, Rubin RJ, Schentag JJ, et al. Budget impact analysis of rapid screening for Staphylococcus aureus colonization among patients undergoing elective surgery in US hospitals. Infect Control Hosp Epidemiol 2008; 29:16-24. This model-based analysis showed that the cost savings of rapid testing and decolonization of S. aureus before surgery in the year 2004 were estimated at $231 538 400. The mean number of hospital days was reduced by 364 919 and a mean of 935 in-hospital deaths caused by S. aureus infections could be avoided.