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Camus, Christophe Sauvadet, Elise Tavenard, Aude Piau, Caroline Uhel, Fabrice Bouju, Pierre Letheulle, Julien Dollo, Gilles Gacouin, Arnaud Lavoué, Sylvain and Le Tulzo, Yves 2016. Decline of multidrug-resistant Gram negative infections with the routine use of a multiple decontamination regimen in ICU. Journal of Infection, Vol. 73, Issue. 3, p. 200.
George, Susan Leasure, A. Renee and Horstmanshof, Douglas 2016. Effectiveness of Decolonization With Chlorhexidine and Mupirocin in Reducing Surgical Site Infections. Dimensions of Critical Care Nursing, Vol. 35, Issue. 4, p. 204.
Nair, Rajeshwari Perencevich, Eli N. Blevins, Amy E. Goto, Michihiko Nelson, Richard E. Schweizer, Marin L. and Weinstein, Robert A. 2016. Clinical Effectiveness of Mupirocin for PreventingStaphylococcus aureusInfections in Nonsurgical Settings: A Meta-analysis. Clinical Infectious Diseases, Vol. 62, Issue. 5, p. 618.
López-Alcalde, Jesús Mateos-Mazón, Marta Guevara, Marcela Conterno, Lucieni O Solà, Ivan Cabir Nunes, Sheila Bonfill Cosp, Xavier and López-Alcalde, Jesús 2015. Cochrane Database of Systematic Reviews.
Camus, Christophe Salomon, Sylvain Bouchigny, Claire Gacouin, Arnaud Lavoué, Sylvain Donnio, Pierre-Yves Javaudin, Loic Chapplain, Jean-Marc Uhel, Fabrice Le Tulzo, Yves and Bellissant, Eric 2014. Short-Term Decline in All-Cause Acquired Infections With the Routine Use of a Decontamination Regimen Combining Topical Polymyxin, Tobramycin, and Amphotericin B With Mupirocin and Chlorhexidine in the ICU. Critical Care Medicine, Vol. 42, Issue. 5, p. 1121.
Derde, Lennie P G Cooper, Ben S Goossens, Herman Malhotra-Kumar, Surbhi Willems, Rob J L Gniadkowski, Marek Hryniewicz, Waleria Empel, Joanna Dautzenberg, Mirjam J D Annane, Djillali Aragão, Irene Chalfine, Annie Dumpis, Uga Esteves, Francisco Giamarellou, Helen Muzlovic, Igor Nardi, Giuseppe Petrikkos, George L Tomic, Viktorija Martí, Antonio Torres Stammet, Pascal Brun-Buisson, Christian and Bonten, Marc J M 2014. Interventions to reduce colonisation and transmission of antimicrobial-resistant bacteria in intensive care units: an interrupted time series study and cluster randomised trial. The Lancet Infectious Diseases, Vol. 14, Issue. 1, p. 31.
Köck, R Becker, K Cookson, B van Gemert-Pijnen, J Harbarth, S Kluytmans, J Mielke, M Peters, G Skov, R Struelens, M Tacconelli, E Witte, W and Friedrich, A 2014. Systematic literature analysis and review of targeted preventive measures to limit healthcare-associated infections by meticillin-resistant Staphylococcus aureus. Eurosurveillance, Vol. 19, Issue. 29, p. 20860.
KRISTENSEN, M. L. VESTERGAARD, T. R. and BÜLOW, H.-H. 2014. Gender differences in randomised, controlled trials in intensive care units. Acta Anaesthesiologica Scandinavica, Vol. 58, Issue. 7, p. 788.
Ruscher, C. 2014. Empfehlungen zur Prävention und Kontrolle von Methicillin-resistenten Staphylococcus aureus-Stämmen (MRSA) in medizinischen und pflegerischen Einrichtungen. Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz, Vol. 57, Issue. 6, p. 695.
Ziakas, Panayiotis D. Anagnostou, Theodora and Mylonakis, Eleftherios 2014. The Prevalence and Significance of Methicillin-Resistant Staphylococcus aureus Colonization at Admission in the General ICU Setting. Critical Care Medicine, Vol. 42, Issue. 2, p. 433.
Camus, C. 2013. Faut-il décoloniser les patients porteurs de staphylocoques dorés résistants à la méticilline en réanimation ?. Réanimation, Vol. 22, Issue. 3, p. 297.
Ciccolini, Mariano Donker, Tjibbe Köck, Robin Mielke, Martin Hendrix, Ron Jurke, Annette Rahamat-Langendoen, Janette Becker, Karsten Niesters, Hubert G.M. Grundmann, Hajo and Friedrich, Alexander W. 2013. Infection prevention in a connected world: The case for a regional approach. International Journal of Medical Microbiology, Vol. 303, Issue. 6-7, p. 380.
Jurke, A Köck, R Becker, K Thole, S Hendrix, R Rossen, J Daniels-Haardt, I and Friedrich, A 2013. Reduction of the nosocomial meticillin-resistant Staphylococcus aureus incidence density by a region-wide search and follow-strategy in forty German hospitals of the EUREGIO, 2009 to 2011. Eurosurveillance, Vol. 18, Issue. 36, p. 20579.
To compare an interventional protocol with a standard protocol for preventing the acquisition of methicillin-resistant Staphylococcus aureus (MRSA) in the intensive care unit (ICU).
Prospective, randomized, controlled, parallel-group, nonblinded clinical trial.
Medical ICUs of 2 French university hospitals.
Five hundred adults with an expected length of stay in the ICU greater than 48 hours.
For the intervention group, the protocol required repeated MRSA screening, contact and droplet isolation precautions for patients at risk for MRSA at ICU admission and for MRSA-positive patients, and decontamination with nasal mupirocin and chlorhexidine body wash for MRSA-positive patients. For the standard group, the standard precautions protocol was used, and the results of repeated MRSA screening in the standard group were not communicated to investigators.
MRSA acquisition rate in the ICU. An audit was conducted to assess compliance with hygiene and isolation precautions.
In the intent-to-treat analysis (n = 488), the MRSA acquisition rate in the ICU was similar in the standard (13 [5.3%] of 243) and intervention (16 [6.5%] of 245) groups (P =.58). The audit showed that the overall compliance rate was 85.5% in the standard group and 84.1% in the intervention group (P =.63), although compliance was higher when isolation precautions were absent than when they were in place (88.2% vs 79.1%; P<.001). MRSA incidence rates were higher without isolation precautions (7.57‰) than with isolation precautions (2.36‰; P =.01).
Individual allocation to MRSA screening, isolation precautions, and decontamination do not provide individual benefit in reducing MRSA acquisition, compared with standard precautions, although the collective risk was lower during the periods of isolation.
Clinicaltrials.gov identifier: NCT00151606.
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