-
Journal of Global Antimicrobial... Mar 2020Staphylococcus aureus is one of the most common pathogens causing nosocomial and community-acquired infections associated with high morbidity and mortality. Mupirocin... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Staphylococcus aureus is one of the most common pathogens causing nosocomial and community-acquired infections associated with high morbidity and mortality. Mupirocin has been increasingly used for treatment of methicillin-susceptible S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA) infections. The aim of this study was to determine the prevalence of mupirocin-resistant S. aureus (MuRSA), mupirocin-resistant MRSA (MuRMRSA), high-level MuRSA (HLMuRSA) and high-level MuRMRSA (HLMuRMRSA) worldwide.
METHODS
Online databases including Medline, Embase and Web of Science were searched (2000-2018) to identify studies addressing the prevalence of MuRSA, MuRMRSA, HLMuRSA and HLMuRMRSA. STATA v. software was used to interpret the data.
RESULTS
Of the 2243 records identified from the databases, 30 and 63 studies fulfilled the eligibility criteria for MuRSA and MuRMRSA, respectively. Finally, 27 and 60 studies were included separately for HLMuRSA and HLMuRMRSA, respectively. The analyses revealed pooled and averaged prevalences of MuRSA, MuRMRSA, HLMuRSA and HLMuRMRSA of 7.6% [95% confidence interval (CI) 6.2-9.0%], 13.8% (95% CI 12.0-15.6%), 8.5% (95% CI 6.3-10.7%) and 8.1% (95% CI 6.8-9.4%), respectively.
CONCLUSION
Overall, these results show a global increase in the prevalence of HLMuRSA and HLMuRMRSA among clinical S. aureus isolates over time. However, there was only a significant increase in the prevalence of MuRMRSA compared with the other categories, especially MuRSA. Since mupirocin remains the most effective antibiotic for MSSA and MRSA decolonisation both in patients and healthcare personnel, a reduction of its effectiveness presents a risk for invasive infection. Monitoring of mupirocin resistance development remains critical.
Topics: Community-Acquired Infections; Cross Infection; Drug Resistance, Bacterial; Humans; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mupirocin; Population Surveillance; Prevalence; Staphylococcal Infections
PubMed: 31442624
DOI: 10.1016/j.jgar.2019.07.032 -
The Cochrane Database of Systematic... Sep 2020Despite the health benefits of breastfeeding, initiation and duration rates continue to fall short of international guidelines. Many factors influence a woman's decision... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Despite the health benefits of breastfeeding, initiation and duration rates continue to fall short of international guidelines. Many factors influence a woman's decision to wean; the main reason cited for weaning is associated with lactation complications, such as mastitis. Mastitis is an inflammation of the breast, with or without infection. It can be viewed as a continuum of disease, from non-infective inflammation of the breast to infection that may lead to abscess formation.
OBJECTIVES
To assess the effectiveness of preventive strategies (for example, breastfeeding education, pharmacological treatments and alternative therapies) on the occurrence or recurrence of non-infective or infective mastitis in breastfeeding women post-childbirth.
SEARCH METHODS
We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (3 October 2019), and reference lists of retrieved studies.
SELECTION CRITERIA
We included randomised controlled trials of interventions for preventing mastitis in postpartum breastfeeding women. Quasi-randomised controlled trials and trials reported only in abstract form were eligible. We attempted to contact the authors to obtain any unpublished results, wherever possible. Interventions for preventing mastitis may include: probiotics, specialist breastfeeding advice and holistic approaches. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for inclusion and risk of bias, extracted data and assessed the certainty of the evidence using GRADE.
MAIN RESULTS
We included 10 trials (3034 women). Nine trials (2395 women) contributed data. Generally, the trials were at low risk of bias in most domains but some were high risk for blinding, attrition bias, and selective reporting. Selection bias (allocation concealment) was generally unclear. The certainty of evidence was downgraded due to risk of bias and to imprecision (low numbers of women participating in the trials). Conflicts of interest on the part of trial authors, and the involvement of industry funders may also have had an impact on the certainty of the evidence. Most trials reported our primary outcome of incidence of mastitis but there were almost no data relating to adverse effects, breast pain, duration of breastfeeding, nipple damage, breast abscess or recurrence of mastitis. Probiotics versus placebo Probiotics may reduce the risk of mastitis more than placebo (risk ratio (RR) 0.51, 95% confidence interval (CI) 0.35 to 0.75; 2 trials; 399 women; low-certainty evidence). It is uncertain if probiotics reduce the risk of breast pain or nipple damage because the certainty of evidence is very low. Results for the biggest of these trials (639 women) are currently unavailable due to a contractual agreement between the probiotics supplier and the trialists. Adverse effects were reported in one trial, where no woman in either group experienced any adverse effects. Antibiotics versus placebo or usual care The risk of mastitis may be similar between antibiotics and usual care or placebo (RR 0.37, 95% CI 0.10 to 1.34; 3 trials; 429 women; low-certainty evidence). The risk of mastitis may be similar between antibiotics and fusidic acid ointment (RR 0.22, 95% CI 0.03 to 1.81; 1 trial; 36 women; low-certainty evidence) or mupirocin ointment (RR 0.44, 95% CI 0.05 to 3.89; 1 trial; 44 women; low-certainty evidence) but we are uncertain due to the wide CIs. None of the trials reported adverse effects. Topical treatments versus breastfeeding advice The risk of mastitis may be similar between fusidic acid ointment and breastfeeding advice (RR 0.77, 95% CI 0.27 to 2.22; 1 trial; 40 women; low-certainty evidence) and mupirocin ointment and breastfeeding advice (RR 0.39, 95% CI 0.12 to 1.35; 1 trial; 48 women; low-certainty evidence) but we are uncertain due to the wide CIs. One trial (42 women) compared topical treatments to each other. The risk of mastitis may be similar between fusidic acid and mupirocin (RR 0.51, 95% CI 0.13 to 2.00; low-certainty evidence) but we are uncertain due to the wide CIs. Adverse events were not reported. Specialist breastfeeding education versus usual care The risk of mastitis (RR 0.93, 95% CI 0.17 to 4.95; 1 trial; 203 women; low-certainty evidence) and breast pain (RR 0.93, 95% CI 0.36 to 2.37; 1 trial; 203 women; low-certainty evidence) may be similar but we are uncertain due to the wide CIs. Adverse events were not reported. Anti-secretory factor-inducing cereal versus standard cereal The risk of mastitis (RR 0.24, 95% CI 0.03 to 1.72; 1 trial; 29 women; low-certainty evidence) and recurrence of mastitis (RR 0.39, 95% CI 0.03 to 4.57; 1 trial; 7 women; low-certainty evidence) may be similar but we are uncertain due to the wide CIs. Adverse events were not reported. Acupoint massage versus routine care Acupoint massage probably reduces the risk of mastitis compared to routine care (RR 0.38, 95% CI 0.19 to 0.78;1 trial; 400 women; moderate-certainty evidence) and breast pain (RR 0.13, 95% CI 0.07 to 0.23; 1 trial; 400 women; moderate-certainty evidence). Adverse events were not reported. Breast massage and low frequency pulse treatment versus routine care Breast massage and low frequency pulse treatment may reduce risk of mastitis (RR 0.03, 95% CI 0.00 to 0.21; 1 trial; 300 women; low-certainty evidence). Adverse events were not reported.
AUTHORS' CONCLUSIONS
There is some evidence that acupoint massage is probably better than routine care, probiotics may be better than placebo, and breast massage and low frequency pulse treatment may be better than routine care for preventing mastitis. However, it is important to note that we are aware of at least one large trial investigating probiotics whose results have not been made public, therefore, the evidence presented here is incomplete. The available evidence regarding other interventions, including breastfeeding education, pharmacological treatments and alternative therapies, suggests these may be little better than routine care for preventing mastitis but our conclusions are uncertain due to the low certainty of the evidence. Future trials should recruit sufficiently large numbers of women in order to detect clinically important differences between interventions and results of future trials should be made publicly available.
Topics: Anti-Bacterial Agents; Bias; Breast Feeding; Edible Grain; Female; Fusidic Acid; Humans; Massage; Mastitis; Mupirocin; Neuropeptides; Ointments; Patient Education as Topic; Placebos; Probiotics; Randomized Controlled Trials as Topic
PubMed: 32987448
DOI: 10.1002/14651858.CD007239.pub4 -
The Cochrane Database of Systematic... Apr 2017Peritoneal dialysis (PD) is an important therapy for patients with end-stage kidney disease and is used in more than 200,000 such patients globally. However, its value... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Peritoneal dialysis (PD) is an important therapy for patients with end-stage kidney disease and is used in more than 200,000 such patients globally. However, its value is often limited by the development of infections such as peritonitis and exit-site and tunnel infections. Multiple strategies have been developed to reduce the risk of peritonitis including antibiotics, topical disinfectants to the exit site and antifungal agents. However, the effectiveness of these strategies has been variable and are based on a small number of randomised controlled trials (RCTs). The optimal preventive strategies to reduce the occurrence of peritonitis remain unclear.This is an update of a Cochrane review first published in 2004.
OBJECTIVES
To evaluate the benefits and harms of antimicrobial strategies used to prevent peritonitis in PD patients.
SEARCH METHODS
We searched the Cochrane Kidney and Transplant's Specialised Register to 4 October 2016 through contact with the Information Specialist using search terms relevant to this review. Studies contained in the Specialised Register are identified through search strategies specifically designed for CENTRAL, MEDLINE, and EMBASE; handsearching conference proceedings; and searching the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov.
SELECTION CRITERIA
RCTs or quasi-RCTs in patients receiving chronic PD, which evaluated any antimicrobial agents used systemically or locally to prevent peritonitis or exit-site/tunnel infection were included.
DATA COLLECTION AND ANALYSIS
Two authors independently assessed risk of bias and extracted data. Summary estimates of effect were obtained using a random-effects model, and results were expressed as risk ratio (RR) with 95% confidence intervals (CI).
MAIN RESULTS
Thirty-nine studies, randomising 4435 patients, were included. Twenty additional studies have been included in this update. The risk of bias domains were often unclear or high; risk of bias was judged to be low in 19 (49%) studies for random sequence generation, 12 (31%) studies for allocation concealment, 22 (56%) studies for incomplete outcome reporting, and in 12 (31%) studies for selective outcome reporting. Blinding of participants and personnel was considered to be at low risk of bias in 8 (21%) and 10 studies (26%) for blinding of outcome assessors. It should be noted that blinding of participants and personnel was not possible in many of the studies because of the nature of the intervention or control treatment.The use of oral or topical antibiotic compared with placebo/no treatment, had uncertain effects on the risk of exit-site/tunnel infection (3 studies, 191 patients, low quality evidence: RR 0.45, 95% CI 0.19 to 1.04) and the risk of peritonitis (5 studies, 395 patients, low quality evidence: RR 0.82, 95% CI 0.57 to 1.19).The use of nasal antibiotic compared with placebo/no treatment had uncertain effects on the risk of exit-site/tunnel infection (3 studies, 338 patients, low quality evidence: RR 1.34, 95% CI 0.62 to 2.87) and the risk of peritonitis (3 studies, 338 patients, low quality evidence: RR 0.94, 95% CI 0.67 to 1.31).Pre/perioperative intravenous vancomycin compared with no treatment may reduce the risk of early peritonitis (1 study, 177 patients, low quality evidence: RR 0.08, 95% CI 0.01 to 0.61) but has an uncertain effect on the risk of exit-site/tunnel infection (1 study, 177 patients, low quality evidence: RR 0.36, 95% CI 0.10 to 1.32).The use of topical disinfectant compared with standard care or other active treatment (antibiotic or other disinfectant) had uncertain effects on the risk of exit-site/tunnel infection (8 studies, 973 patients, low quality evidence, RR 1.00, 95% CI 0.75 to 1.33) and the risk of peritonitis (6 studies, 853 patients, low quality evidence: RR 0.83, 95% CI 0.65 to 1.06).Antifungal prophylaxis with oral nystatin/fluconazole compared with placebo/no treatment may reduce the risk of fungal peritonitis occurring after a patient has had an antibiotic course (2 studies, 817 patients, low quality evidence: RR 0.28, 95% CI 0.12 to 0.63).No intervention reduced the risk of catheter removal or replacement. Most of the available studies were small and of suboptimal quality. Only six studies enrolled 200 or more patients.
AUTHORS' CONCLUSIONS
In this update, we identified limited data from RCTs and quasi-RCTs which evaluated strategies to prevent peritonitis and exit-site/tunnel infections. This review demonstrates that pre/peri-operative intravenous vancomycin may reduce the risk of early peritonitis and that antifungal prophylaxis with oral nystatin or fluconazole reduces the risk of fungal peritonitis following an antibiotic course. However, no other antimicrobial interventions have proven efficacy. In particular, the use of nasal antibiotic to eradicate Staphylococcus aureus, had an uncertain effect on the risk of peritonitis and raises questions about the usefulness of this approach. Given the large number of patients on PD and the importance of peritonitis, the lack of adequately powered and high quality RCTs to inform decision making about strategies to prevent peritonitis is striking.
Topics: Administration, Intranasal; Administration, Topical; Anti-Bacterial Agents; Anti-Infective Agents, Local; Antibiotic Prophylaxis; Antifungal Agents; Catheter-Related Infections; Device Removal; Humans; Injections, Intravenous; Mupirocin; Mycoses; Peritoneal Dialysis; Peritonitis; Randomized Controlled Trials as Topic; Vancomycin
PubMed: 28390069
DOI: 10.1002/14651858.CD004679.pub3 -
Neuromodulation : Journal of the... Jul 2023Staphylococcus aureus (S aureus) is the foremost bacterial cause of surgical-site infection (SSI) and is a common source of neuromodulation SSI. Endogenous colonization... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Staphylococcus aureus (S aureus) is the foremost bacterial cause of surgical-site infection (SSI) and is a common source of neuromodulation SSI. Endogenous colonization is an independent risk factor for SSI; however, this risk has been shown to diminish with screening and decolonization.
MATERIALS AND METHODS
A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using the PubMed, Cochrane Library, and Embase data bases from inception to January 1, 2022, for the purposes of identifying all studies reporting on the use of S aureus swabbing and/or decolonization before neuromodulation procedures. A random-effects meta-analysis was performed using the metaphor package in R to calculate odds ratios (OR).
RESULTS
Five observational cohort studies were included after applying the inclusion and exclusion criteria. The average study duration was 6.6 ± 3.8 years. Three studies included nasal screening as a prerequisite for subsequent decolonization. Type of neuromodulation included spinal cord stimulation in two studies, deep brain stimulation in two studies, intrathecal baclofen in one study, and sacral neuromodulation in one study. Overall, 860 and 1054 patients were included in a control or intervention (ie, screening and/or decolonization) group, respectively. A combination of nasal mupirocin ointment and a body wash, most commonly chlorhexidine gluconate soap, was used to decolonize throughout. Overall infection rates were observed at 59 of 860 (6.86%) and ten of 1054 (0.95%) in the control and intervention groups, respectively. Four studies reported a significant difference. The OR for intervention (screen and/or decolonization) vs no intervention was 0.19 (95% CI, 0.09-0.37; p < 0.001). Heterogeneity between studies was nonsignificant (I = 0.43%, τ = 0.00).
CONCLUSIONS
Preoperative S aureus swabbing and decolonization resulted in significantly decreased odds of infection in neuromodulation procedures. This measure may represent a worthwhile tool to reduce neuromodulation SSI, warranting further investigation.
Topics: Humans; Staphylococcus aureus; Mupirocin; Staphylococcal Infections; Surgical Wound Infection; Anti-Bacterial Agents
PubMed: 36198512
DOI: 10.1016/j.neurom.2022.07.013 -
Dimensions of Critical Care Nursing :... 2016Surgical site infections (SSI) are a serious complication of surgery. Staphylococcus aureus (S aureus) is 1 of the most common causative organisms responsible for SSI.... (Review)
Review
BACKGROUND
Surgical site infections (SSI) are a serious complication of surgery. Staphylococcus aureus (S aureus) is 1 of the most common causative organisms responsible for SSI. Patients who are carriers of methicillin-resistant S aureus and methicillin-sensitive S aureus are at increased risk of developing S aureus-associated SSIs. Decolonization of skin with chlorhexidine and nares with mupirocin may reduce the risk of SSI.
OBJECTIVE
The primary object of this systematic review is to examine the effectiveness of preoperative universal decolonization of skin with chlorhexidine and nares with intranasal mupirocin in preventing SSIs.
METHODS
The following databases were searched: Ovid Medline (from 1946 to September week 3, 2015), Embase (1947 to 2015, week 38), EBSCO CINHAL (1980-2015), Cochrane Collaboration for Systematic Reviews, EBM Reviews, and Google Scholar.
STUDY SELECTION
All experimental and nonexperimental studies that evaluated the effect of chlorhexidine in combination with intranasal mupirocin for decolonization were included. Inclusion was limited to published studies written in English. A total of 19 studies were included in this review. One study was deleted from final analysis as other agents were used for skin decolonization.
DATA EXTRACTION
Data were extracted independently by 2 members of the study team. Discrepancies were resolved through discussion.
RESULTS
Decolonization with topical chlorhexidine and intranasal mupirocin resulted in reduction of S aureus SSI and methicillin-resistant S aureus nosocomial infection and eradication of S aureus nasal carriage. Incidence of SSIs was significantly reduced in 10 studies, which was the primary outcome. Four of the 10 studies used preoperative universal decolonization and significant reduction in SSI was observed in cardiac and orthopedic patients.
CONCLUSION
The results of this review indicate the combination of topical chlorhexidine and intranasal mupirocin is effective in reducing S aureus-associated SSIs.
Topics: Anti-Bacterial Agents; Chlorhexidine; Cross Infection; Humans; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Staphylococcus aureus; Surgical Wound Infection
PubMed: 27258958
DOI: 10.1097/DCC.0000000000000192 -
Antimicrobial Resistance and Infection... 2018Mupirocin is widely used for nasal decolonization of to prevent subsequent staphylococcal infection in patients and healthcare personnel. However, the prolonged and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Mupirocin is widely used for nasal decolonization of to prevent subsequent staphylococcal infection in patients and healthcare personnel. However, the prolonged and unrestricted use has led to the emergence of mupirocin-resistant (mupR) . The aim of this systematic review was to investigate the prevalence, phenotypic and molecular characteristics, and geographic spread of mupR in Africa.
METHODS
We examined five electronic databases (EBSCOhost, Google Scholar, ISI Web of Science, MEDLINE, and Scopus) for relevant English articles on screening for mupR from various samples in Africa. In addition, we performed random effects meta-analysis of proportions to determine the pooled prevalence of mupR in Africa. The search was conducted until 3 August 2016.
RESULTS
We identified 43 eligible studies of which 11 (26%) were obtained only through Google Scholar. Most of the eligible studies (28/43; 65%) were conducted in Nigeria (10/43; 23%), Egypt (7/43; 16%), South Africa (6/43; 14%) and Tunisia (5/43; 12%). Overall, screening for mupR was described in only 12 of 54 (22%) African countries. The disk diffusion method was the widely used technique (67%; 29/43) for the detection of mupR in Africa. The -positive isolates were identified in five studies conducted in Egypt ( = 2), South Africa ( = 2), and Nigeria ( = 1). Low-level resistance (LmupR) and high-level resistance (HmupR) were both reported in six human studies from South Africa ( = 3), Egypt ( = 2) and Libya ( = 1). Data on mupR-MRSA was available in 11 studies from five countries, including Egypt, Ghana, Libya, Nigeria and South Africa. The pooled prevalence (based on 11 human studies) of mupR in Africa was 14% (95% CI =6.8 to 23.2%). The proportion of -positive in Africa ranged between 0.5 and 8%. Furthermore, the frequency of isolates that exhibited LmupR, HmupR and mupR-MRSA in Africa were 4 and 47%, 0.5 and 38%, 5 and 50%, respectively.
CONCLUSIONS
The prevalence of mupR in Africa (14%) is worrisome and there is a need for data on administration and use of mupirocin. The disk diffusion method which is widely utilized in Africa could be an important method for the screening and identification of mupR . Moreover, we advocate for surveillance studies with appropriate guidelines for screening mupR in Africa.
Topics: Africa; Animals; Anti-Bacterial Agents; Bacterial Proteins; Cattle; Cattle Diseases; Databases, Bibliographic; Drug Resistance, Bacterial; Humans; Mupirocin; Sheep; Sheep Diseases; Staphylococcal Infections; Staphylococcus aureus
PubMed: 30147868
DOI: 10.1186/s13756-018-0382-5 -
BMC Nephrology Dec 2014This study was performed to evaluate the effectiveness of surveillance for screening and treatment of patients with chronic kidney disease undergoing hemodialysis and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
This study was performed to evaluate the effectiveness of surveillance for screening and treatment of patients with chronic kidney disease undergoing hemodialysis and colonized by Staphylococcus aureus.
METHODS
A systematic review and meta-analysis were performed. The literature search involved the following databases: the Cochrane Controlled Trials Register, Embase, LILACS, CINAHL, SciELO, and PubMed/Medline. The descriptors were "Staphylococcus aureus", "MRSA", "MSSA", "treatment", "decolonization", "nasal carrier", "colonization", "chronic kidney disease", "dialysis", and "haemodialysis" or "hemodialysis". Five randomized controlled trials that exhibited agreement among reviewers as shown by a kappa value of >0.80 were included in the study; methodological quality was evaluated using the STROBE statement. Patients who received various treatments (various treatments group) or topical mupirocin (mupirocin group) were compared with those who received either no treatment or placebo (control group). The outcomes were skin infection at the central venous catheter insertion site and bacteremia.
RESULTS
In total, 2374 patients were included in the analysis, 626 (26.4%) of whom were nasal carriers of S. aureus. The probability of S. aureus infection at the catheter site for hemodialysis was 87% lower in the mupirocin group than in the control group (odds ratio [OR], 0.13; 95% confidence interval [CI], 0.05-0.34; p<0.001). The risk of bacteremia was 82% lower in the mupirocin group than in the control group (OR, 0.18; 95% CI, 0.08-0.42; p<0.001). No statistically significant difference in bacteremia was observed between the various treatments group (excluding mupirocin) and the control group (OR, 0.77; 95% CI, 0.51-1.15; p=0.20).
CONCLUSIONS
Twenty-six percent of patients undergoing hemodialysis were nasal carriers of S. aureus. Of all treatments evaluated, topical mupirocin was the most effective therapy for the reduction of S. aureus catheter site infection and bacteremia in patients undergoing chronic hemodialysis.
Topics: Administration, Topical; Anti-Bacterial Agents; Bacteremia; Carrier State; Catheter-Related Infections; Catheterization, Central Venous; Humans; Mupirocin; Renal Dialysis; Renal Insufficiency, Chronic; Staphylococcal Infections; Staphylococcal Skin Infections
PubMed: 25519998
DOI: 10.1186/1471-2369-15-202 -
American Journal of Surgery Jan 2018Topical antibiotics have been shown to reduce exit-site infection and peritonitis. The aim of this study was to compare infection rates between mupirocin and gentamicin. (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND
Topical antibiotics have been shown to reduce exit-site infection and peritonitis. The aim of this study was to compare infection rates between mupirocin and gentamicin.
METHODS
Multiple comprehensive databases were searched systematically to include relevant randomized controlled trials and observational studies. Pooled risk ratios (RRs) and 95% confidence intervals were calculated for the incidences of exit-site infection and peritonitis.
RESULTS
Seven studies (mupirocin group n = 458, gentamicin group n = 448) were analyzed for exit-site infection. The risk of gram-positive exit-site infection was similar between the groups. Gram-negative exit-site infection rate was higher in the mupirocin group (RR = 2.125, P = 0.037). Six studies were assessed the peritonitis risk. There was no difference in the gram-positive and -negative peritonitis rate.
CONCLUSIONS
Topical use of gentamicin is associated with fewer exit-site infections caused by gram-negative organisms. Gentamicin has comparable efficacy to mupirocin for peritonitis and gram-positive exit-site infection.
Topics: Administration, Topical; Anti-Bacterial Agents; Antibiotic Prophylaxis; Catheter-Related Infections; Gentamicins; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Humans; Models, Statistical; Mupirocin; Peritoneal Dialysis; Peritonitis; Treatment Outcome
PubMed: 28341139
DOI: 10.1016/j.amjsurg.2017.03.005 -
BMC Nephrology Aug 2016This study was performed to evaluate the clinical effectiveness of alternative strategies for the prevention and treatment of patients with chronic kidney disease... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
This study was performed to evaluate the clinical effectiveness of alternative strategies for the prevention and treatment of patients with chronic kidney disease undergoing peritoneal dialysis and colonized by Staphylococcus aureus.
METHODS
A systematic review and meta-analysis were performed. The literature search involved the following databases: the Cochrane Controlled Trials Register, Embase, LILACS, CINAHL, SciELO, and PubMed/Medline. The descriptors were "Staphylococcus aureus," "MRSA," "MSSA," "treatment," "decolonization," "nasal carrier," "colonization," "chronic kidney disease," "dialysis," and "peritoneal dialysis." Randomized controlled trials that exhibited agreement among reviewers as shown by a kappa value of >0.80 were included in the study; methodological quality was evaluated using the STROBE statement. Patients who received various antibiotic treatments (antibiotic group) or topical mupirocin (mupirocin group) were compared with those who received either no treatment or placebo (control group). Patients in the antibiotic group were also compared with those in the mupirocin group.
RESULTS
In total, nine studies involving 839 patients were included in the analysis, 187 (22.3 %) of whom were nasal carriers of S. aureus. The probability of S. aureus infection at the catheter site for peritoneal dialysis was 74 % lower in the mupirocin than control group (odds ratio [OR], 0.26; 95 % confidence interval [CI], 0.14-0.46; p < 0.001), 56 % lower in the antibiotic than control group (OR, 0.44; 95 % CI, 0.19-0.99; p = 0.048), and 52 % lower in the mupirocin than antibiotic group (OR, 0.48; 95 % CI, 0.21-1.10; p = 0.084). The difference in the probability of S. aureus peritonitis in patients undergoing peritoneal dialysis was not statistically significant among the three groups.
CONCLUSIONS
Mupirocin and topical antibiotics were effective for reduction of S. aureus catheter site infection in patients undergoing peritoneal dialysis when compared with no treatment or placebo. However, evidence was insufficient to identify the optimal agent, route, or duration of antibiotics to treat peritonitis.
Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Equipment Contamination; Humans; Peritoneal Dialysis; Renal Insufficiency, Chronic; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome
PubMed: 27527505
DOI: 10.1186/s12882-016-0329-0 -
Journal of Wound, Ostomy, and... 2016Community-associated methicillin-resistant Staphylococcus aureus commonly presents as a skin and soft tissue infection. Recurrence of the infection is common even after... (Review)
Review
BACKGROUND
Community-associated methicillin-resistant Staphylococcus aureus commonly presents as a skin and soft tissue infection. Recurrence of the infection is common even after incision and drainage of the affected area.
OBJECTIVE
This Evidence-Based Report Card reviews whether decolonization strategies will reduce the rate of methicillin-resistant Staphylococcus aureus skin and soft tissue infection (MRSA-SSTI) recurrence or colonization in patients with a history of MRSA-SSTI.
METHODS
A systematic review of the literature was conducted from 1987 to the present day. The studies that were evaluated included individuals with recurrent skin and soft tissue infections that used decolonization procedures to decrease recurrence. The literature search generated 754 articles. Of these, 288 articles were eliminated due to duplication. Of the 466 remaining citations, 372 were not relevant. Of the remaining 94 full-text articles, 12 met the inclusion criteria. These studies were then reviewed and findings synthesized.
FINDINGS
Four studies found topical decolonization procedures were effective in reducing colonization rates. Of the studies that used combination decolonization therapy, 3 of 4 studies showed a decrease in colonization rate. Despite successful decolonization, the rate of SSTI recurrence did not decrease. Two studies that showed a decrease in SSTI recurrence utilized different study parameters. In one study, the decolonization regimen was completed monthly over 1 year. The other study treated family members in addition to the affected individual. Currently, there is insufficient evidence to support the routine use of topical or systemic decolonization regimens to decrease recurrent SSTIs in individuals with a history of MRSA-SSTI.
CONCLUSION
The focus of decolonization should be focused on the prevention and spread of infection. Hygiene education should be provided to patients, household members, and close contacts to reduce infection rates.
Topics: Anti-Infective Agents; Chlorhexidine; Humans; Infection Control; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Recurrence; Soft Tissue Infections; Staphylococcal Skin Infections
PubMed: 27820584
DOI: 10.1097/WON.0000000000000277