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

  • Glenn Ridenour (a1), Russell Lampen (a1), Jeff Federspiel (a1), Steve Kritchevsky (a2), Edward Wong (a1) and Michael Climo (a1)...
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.

Copyright
Corresponding author
Hunter Holmes McGuire Veterans Affairs Medical Center, 1201 Broad Rock Blvd., Section 111, Richmond, VA 23236 (michael.climo@med.va.gov)
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1. MP Jevons Celbenin-resistant staphylococci. BMJ 1961;1:124125.

2. RL Thompson , I Cabezudo , RR Wenzel Epidemiology of nosocomial infections caused by methicillin-resistant Staphylococcus aureus. Ann Intern Med 1982;97:309317.

4. GA Noskin , RJ Rubin , JJ Schentag , 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;165:17561761.

5. JJ Engemann , Y Carmeli , SE Cosgrove , et al. Adverse clinical and economic outcomes attributable to methicillin resistance among patients with Staphylococcus aureus surgical site infection. Clin Infect Dis 2003;36:592598.

6. SI Blot , KH Vandewoude , EA Hoste , FA Colardyn . Outcome and attributable mortality in critically 111 patients with bacteremia involving methicillin-susceptible and methicillin-resistant Staphylococcus aureus. Arch Intern Med 2002;162:22292235.

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;32:470485.

11. HF Wertheim , MC Vos , HA Boelens , 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;56:321325.

12. MC Roghmann , A Siddiqui , K Plaisance , H Standiford . MRSA colonization and the risk of MRSA bacteraemia in hospitalized patients with chronic ulcers. J Hosp Infect 2001;47:98103.

13. C von Eiff , K Becker , K Machka , H Stammer , G Peters . Nasal carriage as a source of Staphylococcus aureus bacteremia. N Engl J Med 2001;344:1116.

14. X Corbella , MA Dominguez , M Pujol , 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;16:351357.

15. M Pujol , C Pena , R Pallares , et al. Nosocomial Staphylococcus aureus bacteremia among nasal carriers of methicillin-resistant and methicillin-susceptible strains. Am J Med 1996;100:509516.

17. P Kotilainen , M Routamaa , R Peltonen , et al. Elimination of epidemic methicillin-resistant Staphylococcus aureus from a university hospital and district institutions, Finland. Emerg Infect Dis 2003;9:169175.

18. E Girou , G Pujade , P Legrand , F Cizeau , C Brun-Buisson . 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;27:543550.

21. P Kotilainen , M Routamaa , R Peltonen , et al. Eradication of methicillin-resistant Staphylococcus aureus from a health center ward and associated nursing home. Arch Intern Med 2001;161:859863.

23. RW Haley , NB Cushion , FC Tenover , et al. Eradication of endemic methicillin-resistant Staphylococcus aureus infections from a neonatal intensive care unit. J Infect Dis 1995;171:614624.

24. S Pastila , KT Sammalkorpi , J Vuopio-Varkila , S Kontiainen , MA Ristola . Control of methicillin-resistant Staphylococcus aureus outbreak involving several hospitals. J Hosp Infect 2004;58:180186.

26. LM Deshpande , AM Fix , MA Pfaller , RN Jones . 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;42:283290.

28. BD Cookson . The emergence of mupirocin resistance: a challenge to infection control and antibiotic prescribing practice. J Antimicrob Chemother 1998;41:1118.

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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
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