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Topical Therapy for Methicillin-Resistant Staphylococcus aureus Colonization Impact on Infection Risk

Published online by Cambridge University Press:  02 January 2015

Ari Robicsek ,
Jennifer L. Beaumont ,
Richard B. Thomson Jr ,
Geetha Govindarajan  and
Lance R. Peterson
Ari Robicsek*
Affiliation:
Departments of Medicine, Northwestern University, Chicago Division of Infectious Diseases, NorthShore University HealthSystem, Evanston, Illinois
Jennifer L. Beaumont
Affiliation:
Center on Outcomes, Research, and Education, NorthShore University HealthSystem, Evanston, Illinois
Richard B. Thomson Jr
Affiliation:
Pathology, Feinberg School of Medicine, Northwestern University, Chicago Division of Microbiology, NorthShore University HealthSystem, Evanston, Illinois
Geetha Govindarajan
Affiliation:
Department of Medicine, NorthShore University HealthSystem, Evanston, Illinois
Lance R. Peterson
Affiliation:
Pathology, Feinberg School of Medicine, Northwestern University, Chicago Division of Microbiology, NorthShore University HealthSystem, Evanston, Illinois
*
NorthShore University HealthSystem, 2650 Ridge Avenue, Burch 124, Evanston, IL 60201 (arobicsek@northshore.org)
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Abstract

Objective.

We evaluated the usefulness of topical decolonization therapy for reducing the risk of methicillin-resistant Staphylococcus aureus (MRSA) infection among MRSA-colonized inpatients.

Design.

Retrospective cohort study.

Setting and Intervention.

Three hospitals with universal surveillance for MRSA; at their physician's discretion, colonized patients could be treated with a 5-day course of nasal mupirocin calcium 2%, twice daily, plus Chlorhexidine gluconate 4% every second day.

Patients and Methods.

MRSA carriers were later retested for colonization (407 subjects; study 1) or followed up for development of MRSA infection (933 subjects; study 2). Multivariable methods were used to determine the impact of decolonization therapy on the risks of sustained colonization (in study 1) and MRSA infection (in study 2).

Results.

Independent risk factors for sustained colonization included residence in a long-term care facility (odds ratio [OR], 1.8 [95% confidence interval {CI}, 1.1–3.2]) and a pressure ulcer (OR, 2.3 195% CI, 1.2–4.4]). Mupirocin at any dose decreased this risk, particularly during the 30-60-day period after therapy; mupirocin resistance increased this risk (OR, 4.1 [95% CI, 1.6–10.7]). Over a median follow-up duration of 269 days, 69 (7.4%) of 933 patients developed infection. Independent risk factors for infection were length of stay (hazard ratio [HR], 1.2 per 5 additional days [95% CI, 1.0–1.4]), chronic lung disease (HR, 1.7 [95% CI, 1.0–2.8]), and receipt of non-MRSA-active systemic antimicrobial agents (HR, 1.8 [95% CI, 1.1–3.1]). Receipt of mupirocin did not affect the risk of infection, although there was a trend toward delayed infection among patients receiving mupirocin (median time to infection, 50 vs 15.5 days; P = .06).

Conclusions.

Mupirocin-based decolonization therapy temporarily reduced the risk of continued colonization but did not decrease the risk of subsequent infection.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 30 , Issue 7 , July 2009 , pp. 623 - 632
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

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