Prevention of Surgical Site Infections: Decontamination With Mupirocin Based on Preoperative Screening for Staphylococcus aureus Carriers or Universal Decontamination?

Perioperative decolonization of Staphylococcus aureus nasal carriers with mupirocin together with chlorhexidine body washing reduces the incidence of S. aureus surgical site infection. A targeted strategy, applied in S. aureus carriers only, is costly, and implementation may reduce effectiveness. Un...

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Bibliographic Details
Published in:Clinical infectious diseases 2016-03, Vol.62 (5), p.631-636
Main Authors: Hetem, David J., Bootsma, Martin C. J., Bonten, Marc J. M.
Format: Article
Language:English
Subjects:
Administration, Intranasal
Baths
Chlorhexidine - administration & dosage
Chlorhexidine - therapeutic use
Decontamination
Disease transmission
Drug resistance
Drug Resistance, Bacterial
HEALTHCARE EPIDEMIOLOGY
Humans
Infectious diseases
Models, Biological
Mupirocin - administration & dosage
Mupirocin - therapeutic use
Nose - microbiology
Ointments
Risk assessment
Staphylococcal Infections - prevention & control
Staphylococcus aureus - drug effects
Staphylococcus infections
Surgical Wound Infection - prevention & control
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Summary:Perioperative decolonization of Staphylococcus aureus nasal carriers with mupirocin together with chlorhexidine body washing reduces the incidence of S. aureus surgical site infection. A targeted strategy, applied in S. aureus carriers only, is costly, and implementation may reduce effectiveness. Universal decolonization is more cost-effective but increases exposure of noncarriers to mupirocin and the risk of resistance to mupirocin in staphylococci. High-level mupirocin resistance in S. aureus can emerge through horizontal gene transfer originating from coagulase-negative staphylococci (CoNS) and through clonal transmission. The current evidence on the occurrence of high-level mupirocin resistance in S. aureus and CoNS, in combination with the results of mathematical modeling, strongly suggests that the increased selection of high-level mupirocin resistance in CoNS does not constitute an important risk for high-level mupirocin resistance in S. aureus. Compared with a targeted strategy, universal decolonization seems associated with an equally low risk of mupirocin resistance in S. aureus.
ISSN:1058-4838
1537-6591
DOI:10.1093/cid/civ990