Decolonize Carriers of S. aureus Within 24 Hours

WASHINGTON — Identifying newly admitted patients who are colonized with Staphylococcus aureus and beginning decolonization within the first 24 hours can reduce nosocomial infections by almost two-thirds, according to the results of a randomized study of more than 900 patients.

The occurrence of nosocomial S. aureus infection in patients at risk for such infections “can be reduced by almost 60% if carriers are treated with mupirocin and chlorhexidine within 24 hours of admission,” Dr. Lonneke Bode said at the jointly held annual Interscience Conference on Antimicrobial Agents and Chemotherapy and the annual meeting of the Infectious Diseases Society of America.

In the trial, Dr. Bode and her colleagues evaluated whether the identification of S. aureus carriers by using real-time polymerase chain reaction (PCR) on nasal specimens, followed by prompt treatment with mupirocin nasal ointment and chlorhexidine gluconate medicated soap, reduced the risk of nosocomial S. aureus infection in carriers.

Several earlier studies looked at the decolonization of newly admitted patients, but the results to date have been mixed. “Our study differed from previous studies in several aspects,” noted Dr. Bode of the department of medical microbiology and infectious diseases at Erasmus Medical Centre, Rotterdam, the Netherlands.

First, they targeted only nasal S. aureus carriers for intervention. Second, they assessed carriage using real-time PCR on the day of admission, allowing decolonization of carriers to be started within 24 hours of admission. Third, they aimed to eradicate S. aureus carriage not only from the nose but also from the skin. This was accomplished by using twice-daily intranasal mupirocin in combination with daily total body washes using chlorhexidine soap for 5 days. Last, recolonization of patients with extended hospital stays was prevented by repeating this procedure at weeks 3 and 6.

The trial was conducted at three university hospitals and two general hospitals in the Netherlands. They included patients from wards predetermined to have a high incidence of S. aureus nosocomial infections. Immediately on admission, a nasal swab was collected and assessed by PCR. A total of 6,771 patients was assessed between October 2005 and June 2007.

Patients who were positive for S. aureus were randomized to the intervention or to placebo nasal treatment and soap. Intervention or placebo was started within 24 hours of admission, in patients with an expected length of stay of at least 4 days. Exclusion criteria included S. aureus infection at the time of randomization and the use of mupirocin in the preceding 4 weeks. Patients were followed for up to 6 weeks after discharge. Nosocomial infections were defined by Centers for Disease Control and Prevention criteria.

In all, 917 patients were randomized—504 to the intervention and 413 to placebo. The S. aureus infection rate was 3.4% in the intervention group and 7.7% in the placebo group, a difference that was statistically significant. This resulted in a relative risk of infection of 0.42 with the intervention.

Though most of the infections were endogenous, the number of endogenous infections was significantly lower in the intervention group (2%) than in the placebo group (6%). The relative risk of endogenous infection with the intervention was 0.39.

Surgical site infections also were significantly less common in the intervention group (2%) than in the placebo group (7%), for a relative risk of 0.30.

Although there was no significant difference between the two groups in terms of all-cause mortality, the mean length of stay was significantly shorter for the intervention group (12 days), compared with the placebo group (14 days).

Dr. Bode did not report whether she had any potential conflicts of interest.

WASHINGTON — Identifying newly admitted patients who are colonized with Staphylococcus aureus and beginning decolonization within the first 24 hours can reduce nosocomial infections by almost two-thirds, according to the results of a randomized study of more than 900 patients.

The occurrence of nosocomial S. aureus infection in patients at risk for such infections “can be reduced by almost 60% if carriers are treated with mupirocin and chlorhexidine within 24 hours of admission,” Dr. Lonneke Bode said at the jointly held annual Interscience Conference on Antimicrobial Agents and Chemotherapy and the annual meeting of the Infectious Diseases Society of America.

In the trial, Dr. Bode and her colleagues evaluated whether the identification of S. aureus carriers by using real-time polymerase chain reaction (PCR) on nasal specimens, followed by prompt treatment with mupirocin nasal ointment and chlorhexidine gluconate medicated soap, reduced the risk of nosocomial S. aureus infection in carriers.

Several earlier studies looked at the decolonization of newly admitted patients, but the results to date have been mixed. “Our study differed from previous studies in several aspects,” noted Dr. Bode of the department of medical microbiology and infectious diseases at Erasmus Medical Centre, Rotterdam, the Netherlands.

First, they targeted only nasal S. aureus carriers for intervention. Second, they assessed carriage using real-time PCR on the day of admission, allowing decolonization of carriers to be started within 24 hours of admission. Third, they aimed to eradicate S. aureus carriage not only from the nose but also from the skin. This was accomplished by using twice-daily intranasal mupirocin in combination with daily total body washes using chlorhexidine soap for 5 days. Last, recolonization of patients with extended hospital stays was prevented by repeating this procedure at weeks 3 and 6.

The trial was conducted at three university hospitals and two general hospitals in the Netherlands. They included patients from wards predetermined to have a high incidence of S. aureus nosocomial infections. Immediately on admission, a nasal swab was collected and assessed by PCR. A total of 6,771 patients was assessed between October 2005 and June 2007.

Patients who were positive for S. aureus were randomized to the intervention or to placebo nasal treatment and soap. Intervention or placebo was started within 24 hours of admission, in patients with an expected length of stay of at least 4 days. Exclusion criteria included S. aureus infection at the time of randomization and the use of mupirocin in the preceding 4 weeks. Patients were followed for up to 6 weeks after discharge. Nosocomial infections were defined by Centers for Disease Control and Prevention criteria.

In all, 917 patients were randomized—504 to the intervention and 413 to placebo. The S. aureus infection rate was 3.4% in the intervention group and 7.7% in the placebo group, a difference that was statistically significant. This resulted in a relative risk of infection of 0.42 with the intervention.

Though most of the infections were endogenous, the number of endogenous infections was significantly lower in the intervention group (2%) than in the placebo group (6%). The relative risk of endogenous infection with the intervention was 0.39.

Surgical site infections also were significantly less common in the intervention group (2%) than in the placebo group (7%), for a relative risk of 0.30.

Although there was no significant difference between the two groups in terms of all-cause mortality, the mean length of stay was significantly shorter for the intervention group (12 days), compared with the placebo group (14 days).

Dr. Bode did not report whether she had any potential conflicts of interest.

WASHINGTON — Identifying newly admitted patients who are colonized with Staphylococcus aureus and beginning decolonization within the first 24 hours can reduce nosocomial infections by almost two-thirds, according to the results of a randomized study of more than 900 patients.

The occurrence of nosocomial S. aureus infection in patients at risk for such infections “can be reduced by almost 60% if carriers are treated with mupirocin and chlorhexidine within 24 hours of admission,” Dr. Lonneke Bode said at the jointly held annual Interscience Conference on Antimicrobial Agents and Chemotherapy and the annual meeting of the Infectious Diseases Society of America.

In the trial, Dr. Bode and her colleagues evaluated whether the identification of S. aureus carriers by using real-time polymerase chain reaction (PCR) on nasal specimens, followed by prompt treatment with mupirocin nasal ointment and chlorhexidine gluconate medicated soap, reduced the risk of nosocomial S. aureus infection in carriers.

Several earlier studies looked at the decolonization of newly admitted patients, but the results to date have been mixed. “Our study differed from previous studies in several aspects,” noted Dr. Bode of the department of medical microbiology and infectious diseases at Erasmus Medical Centre, Rotterdam, the Netherlands.

First, they targeted only nasal S. aureus carriers for intervention. Second, they assessed carriage using real-time PCR on the day of admission, allowing decolonization of carriers to be started within 24 hours of admission. Third, they aimed to eradicate S. aureus carriage not only from the nose but also from the skin. This was accomplished by using twice-daily intranasal mupirocin in combination with daily total body washes using chlorhexidine soap for 5 days. Last, recolonization of patients with extended hospital stays was prevented by repeating this procedure at weeks 3 and 6.

The trial was conducted at three university hospitals and two general hospitals in the Netherlands. They included patients from wards predetermined to have a high incidence of S. aureus nosocomial infections. Immediately on admission, a nasal swab was collected and assessed by PCR. A total of 6,771 patients was assessed between October 2005 and June 2007.

Patients who were positive for S. aureus were randomized to the intervention or to placebo nasal treatment and soap. Intervention or placebo was started within 24 hours of admission, in patients with an expected length of stay of at least 4 days. Exclusion criteria included S. aureus infection at the time of randomization and the use of mupirocin in the preceding 4 weeks. Patients were followed for up to 6 weeks after discharge. Nosocomial infections were defined by Centers for Disease Control and Prevention criteria.

In all, 917 patients were randomized—504 to the intervention and 413 to placebo. The S. aureus infection rate was 3.4% in the intervention group and 7.7% in the placebo group, a difference that was statistically significant. This resulted in a relative risk of infection of 0.42 with the intervention.

Though most of the infections were endogenous, the number of endogenous infections was significantly lower in the intervention group (2%) than in the placebo group (6%). The relative risk of endogenous infection with the intervention was 0.39.

Surgical site infections also were significantly less common in the intervention group (2%) than in the placebo group (7%), for a relative risk of 0.30.

Although there was no significant difference between the two groups in terms of all-cause mortality, the mean length of stay was significantly shorter for the intervention group (12 days), compared with the placebo group (14 days).

Dr. Bode did not report whether she had any potential conflicts of interest.