Staphylococcus aureus decolonization: Difference between revisions
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Staphylococcus aureus decolonization
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== Project CLEAR == |
== Project CLEAR == |
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* Probably has the best evidence [[CiteRef::huang2019de]] |
* Probably has the best evidence, with an RCT[[CiteRef::huang2019de]] |
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* Decolonization happens for 5 days, twice monthly, for 6 months |
* Decolonization happens for 5 days, twice monthly, for 6 months |
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** 4% rinse-off chlorhexidine for daily bathing or showering |
** 4% rinse-off chlorhexidine for daily bathing or showering |
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== Dutch Method == |
== Dutch Method == |
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* Also has some evidence [[CiteRef::ammerlaan2011er]] |
* Also has some evidence, with an observational study[[CiteRef::ammerlaan2011er]] |
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* Separates patients into uncomplicated (essentially entirely asymptomatic carriage in a low-risk patient) and complicated |
* Separates patients into uncomplicated (essentially entirely asymptomatic carriage in a low-risk patient) and complicated |
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* In the above report, the only reported outcome was decolonization |
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** 63% after 1 cycle, and 80% after up to 5 cycles of treatment |
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** 97% remained decolonized at 3 month follow-up |
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=== Uncomplicated carriage === |
=== Uncomplicated carriage === |
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* As above, plus oral antibiotics |
* As above, plus oral antibiotics |
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* [[ |
* [[Trimethoprim]] 200 mg PO BID or [[doxycycline]] 200 mg PO once daily, plus [[rifampin]] 600 mg twice a day for 1 week |
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* Alternative: [[clindamycin]] 600 mg PO TID or [[clarithromycin]] 500 mg PO BID or [[ciprofloxacin]] 750 mg PO BID or [[fusidic acid]] 500 mg PO TID, plus [[fusidic acid]] 500 mg PO TID |
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{{DISPLAYTITLE:''Staphylococcus aureus'' decolonization}} |
{{DISPLAYTITLE:''Staphylococcus aureus'' decolonization}} |
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Latest revision as of 12:52, 18 August 2021
- Staphylococcus aureus is commonly found in the nares and on the skin of healthy people
- Asymptomatic colonization is associated with a higher rate of invasive infection
Project CLEAR
- Probably has the best evidence, with an RCT1
- Decolonization happens for 5 days, twice monthly, for 6 months
- 4% rinse-off chlorhexidine for daily bathing or showering
- 0.12% chlorhexidine mouthwash twice daily
- 2% nasal mupirocin twice daily
- NNT of about 30 to prevent one infection or one hospitalization
Dutch Method
- Also has some evidence, with an observational study2
- Separates patients into uncomplicated (essentially entirely asymptomatic carriage in a low-risk patient) and complicated
- In the above report, the only reported outcome was decolonization
- 63% after 1 cycle, and 80% after up to 5 cycles of treatment
- 97% remained decolonized at 3 month follow-up
Uncomplicated carriage
- Topical treatment (5 days)
- Mupirocin 2% to nares q8h
- Chlorhexidine or povidone iodide soap applied once daily
- Hygienic measures
- Clean underwear, clothing, washcloths and towels daily
- Change bedsheets every other day during treatment
Complicated carriage
- As above, plus oral antibiotics
- Trimethoprim 200 mg PO BID or doxycycline 200 mg PO once daily, plus rifampin 600 mg twice a day for 1 week
- Alternative: clindamycin 600 mg PO TID or clarithromycin 500 mg PO BID or ciprofloxacin 750 mg PO BID or fusidic acid 500 mg PO TID, plus fusidic acid 500 mg PO TID
References
- ^ Susan S. Huang, Raveena Singh, James A. McKinnell, Steven Park, Adrijana Gombosev, Samantha J. Eells, Daniel L. Gillen, Diane Kim, Syma Rashid, Raul Macias-Gil, Michael A. Bolaris, Thomas Tjoa, Chenghua Cao, Suzie S. Hong, Jennifer Lequieu, Eric Cui, Justin Chang, Jiayi He, Kaye Evans, Ellena Peterson, Gail Simpson, Philip Robinson, Chester Choi, Charles C. Bailey, James D. Leo, Alpesh Amin, Donald Goldmann, John A. Jernigan, Richard Platt, Edward Septimus, Robert A. Weinstein, Mary K. Hayden, Loren G. Miller. Decolonization to Reduce Postdischarge Infection Risk among MRSA Carriers. New England Journal of Medicine. 2019;380(7):638-650. doi:10.1056/nejmoa1716771.
- ^ Heidi S. M. Ammerlaan, Jan A. J. W. Kluytmans, Hanneke Berkhout, Anton Buiting, Els I. G. B. de Brauwer, Peterhans J. van den Broek, Paula van Gelderen, Sander (A.) C. A. P. Leenders, Alewijn Ott, Clemens Richter, Lodewijk Spanjaard, Ingrid J. B. Spijkerman, Frank H. van Tiel, G. Paul Voorn, Mireille W. H. Wulf, Jan van Zeijl, Annet Troelstra, Marc J. M. Bonten, C. M. F. van de Berg, J. Bosman, A. Bremer, W. Bril, D. Commeren, G. van Essen, A. Gigengack-Baars, M. M. E. van Kasteren, E. J. M. Lommerse, E. Mascini, N. H. M Renders, M. van Rijen, J. Schellekens, E. Smeets, T. Sprangers, C. M. J. E. Vandenbroucke-Grauls, A. Verbon, K. Verduin, J. H. T. Wagenvoort, P. van Wijngaarden. Eradication of carriage with methicillin-resistant Staphylococcus aureus: effectiveness of a national guideline. Journal of Antimicrobial Chemotherapy. 2011;66(10):2409-2417. doi:10.1093/jac/dkr243.
