Efficacy and limitation of a Chlorhexidine-Based decolonization strategy in preventing transmission of Methidllin-Resistant staphylococcus aureus in an intensive care unit

Clinical Infectious Diseases

Volumn 50, Issue 2, 2010, Pages 210-217

  Batra, Rahul ^a   Cooper, Ben S ^c   Whiteley, Craig ^a   Patel, Amita K ^a   Wyncoll, Duncan ^a   Edgeworth, Jonathan D ^a,b  

^a GUY'S AND ST THOMAS' NHS FOUNDATION TRUST   (United Kingdom)

^b KING'S COLLEGE LONDON   (United Kingdom)

^c MAHIDOL UNIVERSITY   (Thailand)

Author keywords

[No Author keywords available]

Indexed keywords

BACTERIAL PROTEIN; CHLORHEXIDINE ACETATE; CHLORHEXIDINE GLUCONATE; CX ANTISEPTIC DUSTING POWDER; QACA PROTEIN; QACB PROTEIN; TRICLOSAN; UNCLASSIFIED DRUG;

ADULT; AGED; ANTIBIOTIC RESISTANCE; ANTIBIOTIC SENSITIVITY; ARTICLE; BACTERIAL GENE; BACTERIAL STRAIN; BACTERIAL TRANSMISSION; BACTERIUM ISOLATE; CLINICAL PROTOCOL; CONTROLLED STUDY; DISINFECTION; FEMALE; HOSPITAL BED CAPACITY; HUMAN; IN VITRO STUDY; IN VIVO STUDY; INFECTION CONTROL; INFECTION PREVENTION; INTENSIVE CARE UNIT; MAJOR CLINICAL STUDY; MALE; METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS; METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS INFECTION; MINIMUM INHIBITORY CONCENTRATION; NONHUMAN; PATIENT EDUCATION; PRIORITY JOURNAL;

CHLORHEXIDINE; DISINFECTANTS; FEMALE; HUMANS; INTENSIVE CARE UNITS; MALE; METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS; MIDDLE AGED; RETROSPECTIVE STUDIES; STAPHYLOCOCCAL INFECTIONS;

EID: 73649115314     PISSN: 10584838     EISSN: None     Source Type: Journal    
DOI: 10.1086/648717     Document Type: Article

References (40)

1. Loveday HP, Pellowe CM, Jones SR, Pratt RJ. 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(Suppl 1):S45-70.
2. Calfee DP, Salgado CD, Classen D, et al. Strategies to prevent transmission of methicillin-resistant Staphylococcus aureus in acute care hospitals. Infect Control Hosp Epidemiol 2008; 29(Suppl 1):S62-80.
3. Coia JE, Duckworth GJ, Edwards DI, et al. Guidelines for the control and prevention of methicillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities. J Hosp Infect 2006;63(Suppl 1):S1-44.
4. Siegel JD, Rhinehart E, Jackson M, Chiarello L. 2007 Guideline for isolation precautions: preventing transmission of infectious agents in health care settings. Am J Infect Control 2007; 35(10 Suppl 2):S65-164. (Pubitemid 350213178)
5. Nijssen S, Bonten MJ, Weinstein RA. Are active microbiological surveillance and subsequent isolation needed to prevent the spread of methicillin-resistant Staphylococcus aureus? Clin Infect Dis 2005; 40:405-409 (Pubitemid 40216509)
6. Cepeda JA, Whitehouse T, Cooper B, et al. Isolation of patients in single rooms or cohorts to reduce spread of MRSA in intensive-care units: prospective two-centre study. Lancet 2005; 365:295-304.
7. Girou E, Pujade G, Legrand P, Cizeau F, Brun-Buisson C. Selective screening of carriers for control of methicillin-resistant Staphylococcus aureus (MRSA) in high-risk hospital areas with a high level of endemic MRSA. Clin Infect Dis 1998; 27:543-550
8. Gould IM, MacKenzie FM, MacLennan G, Pacitti D, Watson EJ, Noble DW. Topical antimicrobials in combination with admission screening and barrier precautions to control endemic methicillin-resistant Staphylococcus aureus in an intensive care unit. Int J Antimicrob Agents 2007; 29:536-543
9. Ridenour G, Lampen R, Federspiel J, Kritchevsky S, Wong E, Climo M. Selective use of intranasal mupirocin and Chlorhexidine bathing and the incidence of methicillin-resistant Staphylococcus aureus colonization and infection among intensive care unit patients. Infect Control Hosp Epidemiol 2007; 28:1155-1161
10. Sandri AM, Dalarosa MG, Ruschel de Alcantara L, da Silva Elias L, Zavascki AP. Reduction in incidence of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection in an intensive care unit: role of treatment with mupirocin ointment and Chlorhexidine baths for nasal carriers of MRSA. Infect Control Hosp Epidemiol 2006; 27:185-187
11. Milstone AM, Passaretti CL, Perl TM. Chlorhexidine: expanding the armamentarium for infection control and prevention. Clin Infect Dis 2008; 46:274-281
12. Vernon MO, Hayden MK, Trick WE, Hayes RA, Blom DW, Weinstein RA. Chlorhexidine gluconate to cleanse patients in a medical intensive care unit: the effectiveness of source control to reduce the bioburden of vancomydn-resistant enterococci. Arch Intern Med 2006; 166:306-312
13. 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 (Pubitemid 46079977)
14. Cookson BD, Bolton MC, Platt JH. Chlorhexidine resistance in methicillin-resistant Staphylococcus aureus or just an elevated MIC? an in vitro and in vivo assessment. Antimicrob Agents Chemother 1991; 35:1997-2002.
15. Dupeyron C, Campillo B, Bordes M, Faubert E, Richardet JP, Mangeney N. A clinical trial of mupirocin in the eradication of methicillin-resistant Staphylococcus aureus nasal carriage in a digestive disease unit. J Hosp Infect 2002; 52:281-287
16. Walker ES, Vasquez JE, Dula R, Bullock H, Sarubbi FA. Mupirocinresistant, methicillin-resistant Staphylococcus aureus: does mupirocin remain effective? Infect Control Hosp Epidemiol 2003; 24:342-346
17. Sidhu MS, Heir E, Leegaard T, Wiger K, Hoick A. Frequency of disinfectant resistance genes and genetic linkage with beta-lactamase transposon Tn552 among clinical staphylococci. Antimicrob Agents Chemother 2002; 46:2797-2803 (Pubitemid 34898656)
18. Mayer S, Boos M, Beyer A, Fluit AC, Schmitz FJ. Distribution of the antiseptic resistance genes qacA, qacB and qacC in 497 methicillin-resistant and -susceptible European isolates of Staphylococcus aureus. J Antimicrob Chemother 2001; 47:896-897 (Pubitemid 32519844)
19. Mitchell BA, Paulsen IT, Brown MH, Skurray RA. Bioenergetics of the staphylococcal multidrug export protein QacA: identification of distinct binding sites for monovalent and divalent cations. J Biol Chem 1999; 274:3541-3548
20. Smith K, Gemmell CG, Hunter IS. The association between biocide tolerance and the presence or absence of qac genes among hospitalacquired and community-acquired MRSA isolates. J Antimicrob Chemother 2008; 61:78-84.
21. Vali L, Davies SE, Lai LL, Dave J, Amyes SG. Frequency of biocide resistance genes, antibiotic resistance and the effect of Chlorhexidine exposure on clinical methicillin-resistant Staphylococcus aureus isolates. J Antimicrob Chemother 2008; 61:524-532 (Pubitemid 351321123)
22. Miyazaki NH, Abreu AO, Marin VA, Rezende CA, Moraes MT, Villas Boas MH. The presence of qacA/B gene in Brazilian methicillin-resistant Staphylococcus aureus. Mem Inst Oswaldo Cruz 2007; 102:539-540
23. Wang JT, Sheng WH, Wang JL, et al. Longitudinal analysis of Chlorhexidine susceptibilities of nosocomial methicillin-resistant Staphylococcus aureus isolates at a teaching hospital in Taiwan. J Antimicrob Chemother 2008; 62:514-517
24. Edgeworth JD, Yadegarfar G, Pathak S, et al. An outbreak in an intensive care unit of a strain of methicillin-resistant Staphylococcus aureus sequence type 239 associated with an increased rate of vascular access device-related bacteremia. Clin Infect Dis 2007; 44:493-501.
25. Batra R, Eziefula AC, Wyncoll D, Edgeworth J. Throat and rectal swabs may have an important role in MRSA screening of critically ill patients. Intensive Care Med 2008; 34:1703-1706
26. Hudson IR. The efficacy of intranasal mupirocin in the prevention of staphylococcal infections: a review of recent experience. J Hosp Infect 1994; 27:81-98.
27. Ammerlaan HS, Kluytmans JA, Wertheim HF, Nouwen JL, Bonten MJ. Eradication of methicillin-resistant Staphylococcus aureus carriage: a systematic review. Clin Infect Dis 2009; 48:922-930
28. Barnett AG, Batra R, Graves N, Edgeworth JD, Robotham J, Cooper BS. Estimating the effect of methicillin-resistant Staphylococcus aureus infection on length of stay using a longitudinal model. Am J Epidemiol 2009; 170:1186-1194.
29. Cockfield JD, Pathak S, Edgeworth JD, Lindsay JA. Rapid determination of hospital-acquired methicillin-resistant Staphylococcus aureus lineages. J Med Microbiol 2007; 56(pt 5):614-619
30. Wikler MA LD, Cockerill FR, Sheehan DJ, Craig WA, Tenover FC, Dudley MN. Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically: approved standard-seventh edition. Wayne, PA: CLSI (formerly NCCLS), 2006:M7-A7.
31. Hoeting JA, Madigan D, Raftery AE, Volinsky CT. Bayesian model averaging: a tutorial. Stat Sci 1999; 14:382-401.
32. Team RDC. R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing, 2007.
33. Grundmann H, Hori S, Winter B, Tami A, Austin DJ. Risk factors for the transmission of methicillin-resistant Staphylococcus aureus in an adult intensive care unit: fitting a model to the data. J Infect Dis 2002; 185:481-488
34. Harbarth S, Dharan S, Liassine N, Herrault P, Auckcnthaler R, Pittet D. Randomized, placebo-controlled, double-blind trial to evaluate the efficacy of mupirocin for eradicating carriage of methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother 1999; 43:1412-1416 (Pubitemid 29259335)
35. van Rijen M, Bonten M, Wenzel R, Kluytmans J. Mupirocin ointment for preventing Staphylococcus aureus infections in nasal carriers. Cochrane Database Syst Rev 2008 (4):CD006216.
36. Watanakunakorn C, Axelson C, Bota B, Stahl C. Mupirocin ointment with and without Chlorhexidine baths in the eradication of Staphylococcus aureus nasal carriage in nursing home residents. Am J Infect Control 1995; 23:306-309
37. Wendt C, Schinke S, Wurttemberger M, Oberdorfer K, Bock-Hensley O, von Baum H. Value of whole-body washing with Chlorhexidine for the eradication of methicillin-resistant Staphylococcus aureus: a randomized, placebo-controlled, double-blind clinical trial. Infect Control Hosp Epidemiol 2007; 28:1036-1043
38. Siegel JD, Rhinchart E, Jackson M, Chiarello L. Management of multidrug-resistant organisms in health care settings, 2006. Am J Infect Control 2007; 35(10 Suppl 2):S165-93.
39. Ramsay C, Brown E, Hartman G, Davey P. Room for improvement: a systematic review of the quality of evaluations of interventions to improve hospital antibiotic prescribing. J Antimicrob Chemother 2003; 52:764-771 (Pubitemid 37407802)
40. Robins JM, Greenland S. The role of model selection in causal inference from nonexperimental data. Am J Epidemiol 1986; 123:392-402. (Pubitemid 16101143)