Long-term Mortality After Rapid Screening and Decolonization of Staphylococcus Aureus Carriers: Observational Follow-up Study of a Randomized, Placebo-controlled Trial

OBJECTIVE: To identify patients who benefit most from Staphylococcus aureus screening and decolonization treatment upon admission. BACKGROUND: S. aureus carriers are at increased risk of developing surgical-site infections with S. aureus. Previously, we demonstrated in a randomized, placebo-controlled trial (RCT) that these infections can largely be prevented by detection of carriage and decolonization treatment upon admission. In this study, we analyzed 1- and 3-year mortality rates in both treatment arms of the RCT to identify patient groups that should be targeted when implementing the screen-and-treat strategy. METHODS: Three years after enrolment in the RCT, mortality dates of all surgical patients were checked. One- and 3-year mortality rates were calculated for all patients and for various subgroups. RESULTS: After 3 years, 44 of 431 (10.2%) and 43 of 362 (11.9%) patients had died in the mupirocin/chlorhexidine and placebo groups, respectively. No significant differences in mortality rates were observed between the treatment groups or the subgroups according to type of surgery. In the subgroup of patients with clean procedures (382 cardiothoracic, 167 orthopedic, 61 vascular, and 56 other), mupirocin/chlorhexidine reduced 1-year mortality: 11 of 365 (3.0%) died in the mupirocin/chlorhexidine versus 21 of 301 (7.0%) in the placebo group [hazard ratio = 0.38 (95% CI: 0.18-0.81)]. CONCLUSIONS: Detection and decolonization of S. aureus carriage not only prevents S. aureus surgical-site infections but also reduces 1-year mortality in surgical patients undergoing clean procedures. Such patients with a high risk of developing S. aureus infections should therefore be the primary target when implementing the screen-and-treat strategy in clinical practice

Mupirocin prophylaxis against nosocomial Staphylococcus aureus infections in nonsurgical patients: a randomized study.

Item does not contain fulltextBACKGROUND: Staphylococcus aureus nasal carriage is a major risk factor for nosocomial S. aureus infection. Studies show that intranasal mupirocin can prevent nosocomial surgical site infections. No data are available on the efficacy of mupirocin in nonsurgical patients. OBJECTIVE: To assess the efficacy of mupirocin prophylaxis in preventing nosocomial S. aureus infections in nonsurgical patients. DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: 3 tertiary care academic hospitals and 1 nonacademic hospital. PATIENTS: 1602 culture-proven S. aureus carriers hospitalized in nonsurgical departments. INTERVENTION: Therapy with mupirocin 2% nasal ointment (n = 793) or placebo ointment (n = 809), twice daily for 5 days, started 1 to 3 days after admission. MEASUREMENTS: Nosocomial S. aureus infections according to defined criteria, in-hospital mortality, duration of hospitalization, and time to nosocomial S. aureus infection. Staphylococcus aureus isolates were genotyped to assess whether infection was caused by endogenous strains. RESULTS: The mupirocin and placebo groups did not statistically differ in the rates of nosocomial S. aureus infections (mupirocin, 2.6%; placebo, 2.8%; risk difference, 0.2 percentage point [95% CI, -1.5 to 1.9 percentage points]), mortality (mupirocin, 3.0%; placebo, 2.8%; risk difference, -0.2 percentage point [CI, -1.9 to 1.5 percentage points]), or duration of hospitalization (median for both, 8 days). However, time to nosocomial S. aureus infection was decreased in the mupirocin group from 12 to 25 days (P > 0.2). A total of 77% of S. aureus nosocomial infections were endogenous. LIMITATIONS: A few infections in both groups may have been missed because investigators assessed a patient for infection only if microbiology culture results were positive for S. aureus. CONCLUSION: Routine culture for S. aureus nasal carriage at admission and subsequent mupirocin application does not provide effective prophylaxis against nosocomial S. aureus infections in nonsurgical patients

Associations between Staphylococcus aureus Genotype, Infection, and In-Hospital Mortality: A Nested Case-Control Study.

Item does not contain fulltextWe screened 14,008 adult nonsurgical patients for Staphylococcus aureus nasal carriage at hospital admission and assessed them for invasive S. aureus disease and in-hospital mortality. Multilocus sequence typing was performed on endogenous invasive strains and nasal strains of matched asymptomatic carriers to investigate whether virulent clones could be identified in nasal carriers. Clonal complex (CC) 45 was significantly underrepresented (odds ratio [OR], 0.16 [95% confidence interval {CI}, 0.04-0.59]) and CC30 was overrepresented (not statistically significant) among invasive strains (OR, 1.91 [95% CI, 0.91-4.0]). The distribution of CCs of invasive S. aureus strains in noncarriers did not differ from that in carriers. Those infected with S. aureus strains belonging to a CC had higher mortality than those infected with strains not belonging to a CC (P<.05), which indicates the coevolution of S. aureus virulence and spread in humans

[Optimisation of the antibiotic policy in the Netherlands. XII. The SWAB guideline for antimicrobial eradication of MRSA in carriers].

Item does not contain fulltextThe 'Stichting Werkgroep Antibioticabeleid' (SWAB; Dutch Working Party on Antibiotics Policy) has developed evidence-based guidelines for the antimicrobial treatment of methicillin-resistant Staphylococcus aureus (MRSA) carriers for the eradication of MRSA. A distinction was made between uncomplicated and complicated carriage depending on the presence or absence of an active MRSA infection, skin lesions, foreign body material, mupirocin resistance and/or extranasal carriage. The indication for treatment is determined by the consequences of carriage for the carrier and his/her environment, the adverse events of treatment, and the likelihood of a successful treatment. The first choice of treatment in uncomplicated carriers is a combination of mupirocin nasal ointment and disinfectant soap for 5 days, along with hygiene advice. If treatment fails, sources in the vicinity of the patient must be sought. Complicated carriers receive a combination of 2 oral antibiotics, in addition to mupirocin nasal ointment and disinfectant soap, for at least 7 days

Sustained low prevalence of meticillin-resistant Staphylococcus aureus upon admission to hospital in The Netherlands.

Contains fulltext : 124320.pdf (Publisher’s version ) (Closed access)The prevalence of meticillin-resistant Staphylococcus aureus (MRSA) carriage at hospital admission in The Netherlands was 0.03% in 1999-2000. The aim of the present study was to assess whether the prevalence of MRSA carriage in The Netherlands has changed over the last few years. In five Dutch hospitals, 6496 unique patients were screened for nasal S. aureus carriage at hospital admission by microbiological culture between 1 October 2005 and 7 June 2007. In total, 2036 of 6496 (31.3%) patients carried S. aureus in their nose, and seven of 6496 (0.11%) patients were nasal carriers of MRSA. Compared with 1999-2000, the prevalence of MRSA carriage in the Dutch population at hospital admission has increased more than three fold; however, this increase was not significant (P=0.06, Fisher's exact test). This prevalence is still among the lowest in the world, probably as a result of the stringent Dutch infection control policy, and the restrictive use of antibiotics in The Netherlands.1 november 201

EFEITO DO CARBARYL SOBRE O 'RUSSETING' DA MAÇÃ (MALUS DOMESTICA BORKH.), CULTIVARES 'GALA', 'FUJI' E 'GOLDEN DELICIOUS' EFFECT OF CARBARYL ON RUSSETING OF APPLE (Malus domestica Borkh.), CULTIVARS 'GALA', 'FUJI' AND 'GOLDEN DELICIOUS'

O "russeting" da maçã caracteriza-se por uma camada de cortiça formada entre as células da epiderme e que dá um aspecto de rugosidade à superfície do fruto, depreciando-o para a comercialização. O raleio de frutos é uma prática cultural bastante difundida entre os produtores de maçã. Pode ser efetuada manualmente, quimicamente ou pela associação de ambos. Dentre os produtos mais usados para raleio químico, estão o ácido naftaleno acético (ANA) e o carbaryl, um inseticida carbamato, conhecido comercialmente como Sevinâ. Há duas formulações de carbaryl no mercado brasileiro, mas não existem dados de pesquisa suficientes que permitam escolher a formulação mais adequada. Há citações de que o carbaryl pode causar "russeting" em maçãs. O objetivo deste trabalho foi testar as duas formulações de carbaryl existentes no mercado, quanto ao seu efeito sobre o "russeting" nas maçãs. Os experimentos foram conduzidos em Fraiburgo e em Caçador, Santa Catarina, Brasil. Foram avaliadas duas concentrações, 500 ppm e 1.500 ppm de carbaryl. Foram testadas duas formulações, uma em pó-molhável com 85% de i.a. e outra em suspensão concentrada com 48% de i.a. Como a incidência de "russeting" varia entre cultivares, testou-se em 'Gala', 'Fuji' e 'Golden Delicious', que são as três mais importantes no mercado brasileiro. Os resultados mostraram que: 1) A ocorrência de "russeting" para as três cultivares foi maior em Fraiburgo do que em Caçador; 2) O carbaryl, na formulação solução concentrada, causou mais "russeting" em 'Golden Delicious', em Caçador, indicando que o seu uso deve ser evitado para essa cultivar, dando-se preferência à formulação pó-molhável; 3)Tanto a formulação quanto a concentração de carbaryl não afetaram a incidência de "russeting" nas cultivares 'Gala' e 'Fuji' nos dois locais.<br>Russeting is characterized by the development of a cork layer among the epidermal cells giving an aspect of rugosity to the fruit surface, reducing its marketability. Fruit thinning is a technique widely used by apple growers. It can be done by hand or by using chemical thinning or by both, chemical and hand thinning. Among the most used chemical for thinning are naphthaleneacetic acid (NAA) and the insecticide carbaryl, commonly known as Sevinâ. In the Brazilian market there are two formulations of carbaryl: wetted powder and flowable solution. None of them are registered as chemical thinning for apple in Brazil. However there is not enough official research data in Brazil in this area that could support the best choice as far as russeting on the fruit is concerned. Some authors say that carbaryl may cause russeting on apples. This trial aimed to evaluate the two carbaryl formulations comparing its effect concerned to russeting. The experiments were carried out in two areas: Fraiburgo and Caçador, Santa Catarina State, Brazil. Two concentrations: 500 ppm and 1.500 ppm of each formulation were tested. One of the formulations was a wetted powder with 85% of a.i., the other was a flowable solution with 48% of a.i. As the incidence of russeting on apple may vary according to cultivar, the experiments were carried out on 'Gala', 'Fuji' and 'Golden Delicious'. It was concluded that: 1) Fraiburgo climactic conditions were much more favorable to russeting than those in Caçador; 2) carbaryl did not cause russeting on 'Gala' and 'Fuji' in both locations; 3) Carbaryl as flowable solution caused more russeting in 'Golden Delicious' at Caçador, so this formulation should not be recommended for this cultivar