Eradication of carriage with methicillin-resistant Staphylococcus aureus: determinants of treatment failure

Autor: Hanneke Berkhout, C. Richter, Annelies Verbon, C. M. F. van de Berg, M.W.H. Wulf, Jan Kluytmans, W. Bril, J. Bosman, G A van Essen, Anton Buiting, Marc J. M. Bonten, P van Wijngaarden, J. H. T. Wagenvoort, E. Smeets, Sander Leenders, Els de Brauwer, M. M. L. van Rijen, E. J. M. Lommerse, T. Sprangers, Ellen M. Mascini, Jan van Zeijl, Frank H. van Tiel, Alewijn Ott, Lodewijk Spanjaard, Annet Troelstra, Ada C. M. Gigengack-Baars, Ingrid J. B. Spijkerman, G. Paul Voorn, D. Commeren, M. M. E. van Kasteren, Kees Verduin, Christina M. J. E. Vandenbroucke-Grauls, Peterhans J. van den Broek, A. Bremer, Nicole H. M. Renders, Heidi S. M. Ammerlaan, J. F. P. Schellekens, Paula van Gelderen
Přispěvatelé: AII - Amsterdam institute for Infection and Immunity, Medical Microbiology and Infection Prevention, CCA - Immuno-pathogenesis, Med Microbiol, Infect Dis & Infect Prev, RS: CAPHRI School for Public Health and Primary Care
Jazyk: angličtina
Rok vydání: 2011
Předmět:
Adult
Male
Methicillin-Resistant Staphylococcus aureus
Microbiology (medical)
medicine.medical_specialty
medicine.disease_cause
Treatment failure
Throat
Internal medicine
Humans
Medicine
Pharmacology (medical)
Treatment Failure
Asymptomatic Infections
Aged
Pharmacology
business.industry
Guideline adherence
Chlorhexidine
Dutch guideline
Odds ratio
Guideline
Middle Aged
Staphylococcal Infections
colonization
treatment success
Methicillin-resistant Staphylococcus aureus
Confidence interval
Anti-Bacterial Agents
Surgery
Logistic Models
Mupirocin
Infectious Diseases
medicine.anatomical_structure
Carriage
Carrier State
Practice Guidelines as Topic
Anti-Infective Agents
Local
colonization decolonization treatment success Dutch guideline nosocomial infections household contacts carriers mrsa decolonization transmission prevalence
decolonization
Female
Methicillin Resistance
Guideline Adherence
business
Zdroj: Journal of antimicrobial chemotherapy, 66(10), 2418-2424. Oxford University Press
Journal of Antimicrobial Chemotherapy, 66(10), 2418-2424
Ammerlaan, H S M, Kluijtmans, J A J W, Berkhout, H, Buiting, A, de Brauwer, E I G B, van den Broek, P J, van Gelderen, P, Leenders, S C A P, Ott, A, Richter, C, Spanjaard, L, Spijkerman, I J B, van Tiel, F H, Voorn, G P, Wulf, M W H, van Zeijl, J, Troelstra, A & Bonten, M J M 2011, ' Eradication of carriage with methicillin-resistant Staphylococcus aureus: determinants of treatment failure ', Journal of Antimicrobial Chemotherapy, vol. 66, no. 10, pp. 2418-2424 . https://doi.org/10.1093/jac/dkr250
Journal of Antimicrobial Chemotherapy, 66(10), 2418-2424. Oxford University Press
ISSN: 0305-7453
Popis: Background: Using data from an observational study in which the effectiveness of a guideline for eradication of methicillin-resistant Staphylococcus aureus (MRSA) carriage was evaluated, we identified variables that were associated with treatment failure. Methods: A multivariate logistic regression model was performed with subgroup analyses for uncomplicated and complicated MRSA carriage (the latter including MRSA infection, skin lesions, foreign-body material, mupirocin resistance and/or exclusive extranasal carriage) and for those treated according to the guideline (i.e. mupirocin nasal ointment and chlorhexidine soap solution for uncomplicated carriage, in combination with two oral antibiotics for complicated carriage). Results: Six hundred and thirteen MRSA carriers were included, of whom 333 (54%) had complicated carriage; 327 of 530 patients (62%) with known complexity of carriage were treated according to the guideline with an absolute increase in treatment success of 20% (95% confidence interval 12%-28%). Among those with uncomplicated carriage, guideline adherence [adjusted odds ratio (OR(alpha)) 7.4 (1.7-31.7)], chronic pulmonary disease [OR(alpha) 44 (2.9-668)], throat carriage [OR(alpha) 2.9 (1.4-6.1)], perineal carriage [OR(alpha) 2.2 (1.1-4.4)] and carriage among household contacts [OR(alpha) 5.6 (1.2-26)] were associated with treatment failure. Among those with complicated carriage, guideline adherence was associated with treatment success [OR(alpha) 0.2 (0.1-0.3)], whereas throat carriage [OR(alpha) 4.4 (2.3-8.3)] and dependence in activities of daily living [OR(alpha) 3.6 (1.4-8.9)] were associated with failure. Conclusions: Guideline adherence, especially among those with complicated MRSA carriage, was associated with treatment success. Adding patients with extranasal carriage or dependence in daily self-care activities to the definition of complicated carriage, and treating them likewise, may further increase treatment success.
Databáze: OpenAIRE
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