Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-05T19:42:57.508Z Has data issue: false hasContentIssue false
  • English
  • Français

Selective Use of Intranasal Mupirocin and Chlorhexidine Bathing and the Incidence of Methicillin-Resistant Staphylococcus aureus Colonization and Infection Among Intensive Care Unit Patients

Published online by Cambridge University Press:  02 January 2015

Glenn Ridenour ,
Russell Lampen ,
Jeff Federspiel ,
Steve Kritchevsky ,
Edward Wong  and
Michael Climo
Glenn Ridenour
Affiliation:
Division of Infectious Diseases, Hunter Holmes McGuire Veterans Affairs Medical Center, and theVirginia Commonwealth University Medical Center, Richmond, Virginia
Russell Lampen
Affiliation:
Division of Infectious Diseases, Hunter Holmes McGuire Veterans Affairs Medical Center, and theVirginia Commonwealth University Medical Center, Richmond, Virginia
Jeff Federspiel
Affiliation:
Division of Infectious Diseases, Hunter Holmes McGuire Veterans Affairs Medical Center, and theVirginia Commonwealth University Medical Center, Richmond, Virginia
Steve Kritchevsky
Affiliation:
Department of Internal Medicine, Gerontology, and Geriatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
Edward Wong
Affiliation:
Division of Infectious Diseases, Hunter Holmes McGuire Veterans Affairs Medical Center, and theVirginia Commonwealth University Medical Center, Richmond, Virginia
Michael Climo*
Affiliation:
Division of Infectious Diseases, Hunter Holmes McGuire Veterans Affairs Medical Center, and theVirginia Commonwealth University Medical Center, Richmond, Virginia
*
Hunter Holmes McGuire Veterans Affairs Medical Center, 1201 Broad Rock Blvd., Section 111, Richmond, VA 23236 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To determine whether the use of chlorhexidine bathing and intranasal mupirocin therapy among patients colonized with methicillin-resistant Staphylococcus aureus (MRSA) would decrease the incidence of MRSA colonization and infection among intensive care unit (ICU) patients.

Methods.

After a 9-month baseline period (January 13, 2003, through October 12, 2003) during which all incident cases of MRSA colonization or infection were identified through the use of active-surveillance cultures in a combined medical-coronary ICU, all patients colonized with MRSA were treated with intranasal mupirocin and underwent daily chlorhexidine bathing.

Results.

After the intervention, incident cases of MRSA colonization or infection decreased 52% (incidence density, 8.45 vs 4.05 cases per 1,000 patient-days; P = .048). All MRSA isolates remained susceptible to chlorhexidine; the overall rate of mupirocin resistance was low (4.4%) among isolates identified by surveillance cultures and did not increase during the intervention period.

Conclusions.

We conclude that the selective use of intranasal mupirocin and daily chlorhexidine bathing for patients colonized with MRSA reduced the incidence of MRSA colonization and infection and contributed to reductions identified by active-surveillance cultures. This finding suggests that additional strategies to reduce the incidence of MRSA infection and colonization—beyond expanded surveillance—may be needed.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 10 , October 2007 , pp. 1155 - 1161
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Jevons, MP Celbenin-resistant staphylococci. BMJ 1961;1:124–125.Google Scholar
2. Thompson, RL, Cabezudo, I, Wenzel, RR Epidemiology of nosocomial infections caused by methicillin-resistant Staphylococcus aureus . Ann Intern Med 1982;97:309–317.Google Scholar
3. Cosgrove, SE, Qi, Y, Kaye, KS, Harbarth, S, Karchmer, AW, Carmeli, Y. The impact of methicillin resistance in Staphylococcus aureus bacteremia on patient outcomes: mortality, length of stay, and hospital charges. Infect Control Hosp Epidemiol 2005;26:166–174.Google Scholar
4. Noskin, GA, Rubin, RJ, Schentag, JJ, et al. The burden of Staphylococcus aureus infections on hospitals in the United States: an analysis of the 2000 and 2001 Nationwide Inpatient Sample Database. Arch Intern Med 2005;165:1756–1761.Google Scholar
5. Engemann, JJ, Carmeli, Y, Cosgrove, SE, et al. Adverse clinical and economic outcomes attributable to methicillin resistance among patients with Staphylococcus aureus surgical site infection. Clin Infect Dis 2003;36:592–598.Google Scholar
6. Blot, SI, Vandewoude, KH, Hoste, EA, Colardyn, FA. Outcome and attributable mortality in critically 111 patients with bacteremia involving methicillin-susceptible and methicillin-resistant Staphylococcus aureus . Arch Intern Med 2002;162:2229–2235.Google Scholar
7. Kim, T, Oh, PI, Simor, AE. The economic impact of methicillin-resistant Staphylococcus aureus in Canadian hospitals. Infect Control Hosp Epidemiol 2001;22:99–104.Google Scholar
8. Boyce, JM, Havill, NL, Kohan, C, Dumigan, DG, Ligi, CE. Do infection control measures work for methicillin-resistant Staphylococcus aureus? Infect Control Hosp Epidemiol 2004;25:395–401.Google Scholar
9. National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillance (NNIS) System Report: data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;32:470–485.Google Scholar
10. Ridenour, GA, Wong, ES, Call, MA, Climo, MW. Duration of colonization with methicillin-resistant Staphylococcus aureus among patients in the intensive care unit: implications for intervention. Infect Control Hosp Epidemiol 2006;27:271–278.Google Scholar
11. Wertheim, HF, Vos, MC, Boelens, HA, et al. Low prevalence of methicillin-resistant Staphylococcus aureus (MRSA) at hospital admission in the Netherlands: the value of search and destroy and restrictive antibiotic use. J Hosp Infect 2004;56:321–325.Google Scholar
12. Roghmann, MC, Siddiqui, A, Plaisance, K, Standiford, H. MRSA colonization and the risk of MRSA bacteraemia in hospitalized patients with chronic ulcers. J Hosp Infect 2001;47:98–103.Google Scholar
13. von Eiff, C, Becker, K, Machka, K, Stammer, H, Peters, G. Nasal carriage as a source of Staphylococcus aureus bacteremia. N Engl J Med 2001;344:11–16.Google Scholar
14. Corbella, X, Dominguez, MA, Pujol, M, et al. Staphylococcus aureus nasal carriage as a marker for subsequent staphylococcal infections in intensive care unit patients. Eur J Clin Microbiol Infect Dis 1997;16:351–357.Google Scholar
15. Pujol, M, Pena, C, Pallares, R, et al. Nosocomial Staphylococcus aureus bacteremia among nasal carriers of methicillin-resistant and methicillin-susceptible strains. Am J Med 1996;100:509–516.Google Scholar
16. Muto, CA, Jernigan, JA, Ostrowsky, BE, et al. SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and enterococcus. Infect Control Hosp Epidemiol 2003;24:362–386.Google Scholar
17. Kotilainen, P, Routamaa, M, Peltonen, R, et al. Elimination of epidemic methicillin-resistant Staphylococcus aureus from a university hospital and district institutions, Finland. Emerg Infect Dis 2003;9:169–175.Google Scholar
18. 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.Google Scholar
19. Sandri, AM, Dalarosa, MG, Ruschelde, AL, da Silva, EL, 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.Google Scholar
20. Pan, A, Carnevale, G, Catenazzi, P, et al. Trends in methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections: effect of the MRSA “search and isolate” strategy in a hospital in Italy with hyper-endemic MRSA. Infect Control Hosp Epidemiol 2005;26:127–133.Google Scholar
21. Kotilainen, P, Routamaa, M, Peltonen, R, et al. Eradication of methicillin-resistant Staphylococcus aureus from a health center ward and associated nursing home. Arch Intern Med 2001;161:859–863.Google Scholar
22. Nicolle, LE, Dyck, B, Thompson, G, et al. Regional dissemination and control of epidemic methicillin-resistant Staphylococcus aureus: Manitoba Chapter of CHICA-Canada. Infect Control Hosp Epidemiol 1999;20:202–205.Google Scholar
23. Haley, RW, Cushion, NB, Tenover, FC, et al. Eradication of endemic methicillin-resistant Staphylococcus aureus infections from a neonatal intensive care unit. J Infect Dis 1995;171:614–624.Google Scholar
24. Pastila, S, Sammalkorpi, KT, Vuopio-Varkila, J, Kontiainen, S, Ristola, MA. Control of methicillin-resistant Staphylococcus aureus outbreak involving several hospitals. J Hosp Infect 2004;58:180–186.Google Scholar
25. 26.Wagenvoort, JH. Dutch measures to control MRSA and the expanding European Union. Euro Surveill 2000;5:26–28.Google Scholar
26. Deshpande, LM, Fix, AM, Pfaller, MA, Jones, RN. Emerging elevated mupirocin resistance rates among staphylococcal isolates in the SENTRY Antimicrobial Surveillance Program (2000): correlations of results from disk diffusion, Etest and reference dilution methods. Diagn Microbiol Infect Dis 2002;42:283–290.Google Scholar
27. Annigeri, R, Conly, J, Vas, S, et al. Emergence of mupirocin-resistant Staphylococcus aureus in chronic peritoneal dialysis patients using mupirocin prophylaxis to prevent exit-site infection. Perit Dial Int 2001;21:554–559.Google Scholar
28. Cookson, BD. The emergence of mupirocin resistance: a challenge to infection control and antibiotic prescribing practice. J Antimicrob Chemother 1998;41:11–18.Google Scholar
29. Sunenshine, RH, Liedtke, LA, Fridkin, SK, Strausbaugh, LJ. Management of inpatients colonized or infected with antimicrobial-resistant bacteria in hospitals in the United States. Infect Control Hosp Epidemiol 2005;26:138–143.Google Scholar