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Effectiveness of meticillin-resistant Staphylococcus aureus decolonization in long-term haemodialysis patients: a systematic review and meta-analysis

Gebreselassie, H.M ; Lo Priore, E ; Marschall, J

The Journal of hospital infection, 2015-11, Vol.91 (3), p.250-256 [Periódico revisado por pares]

England: Elsevier Ltd

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Título:
Effectiveness of meticillin-resistant Staphylococcus aureus decolonization in long-term haemodialysis patients: a systematic review and meta-analysis
Autor: Gebreselassie, H.M ; Lo Priore, E ; Marschall, J
Assuntos: Anti-Infective Agents, Local - administration & dosage ; Carrier State - drug therapy ; Carrier State - microbiology ; Chlorhexidine - administration & dosage ; Decolonization ; Disinfection - methods ; Haemodialysis ; Humans ; Infectious Disease ; Methicillin-Resistant Staphylococcus aureus - drug effects ; Methicillin-Resistant Staphylococcus aureus - isolation & purification ; Meticillin-resistant Staphylococcus aureus ; Mupirocin - administration & dosage ; Nasal Mucosa - microbiology ; Renal Dialysis ; Staphylococcal Infections - drug therapy ; Staphylococcal Infections - microbiology ; Treatment Outcome
É parte de: The Journal of hospital infection, 2015-11, Vol.91 (3), p.250-256
Notas: ObjectType-Article-2
SourceType-Scholarly Journals-1
ObjectType-Feature-1
ObjectType-Review-4
ObjectType-Undefined-3
Descrição: Summary Background Chronic haemodialysis patients are a high-risk population for meticillin-resistant Staphylococcus aureus (MRSA) colonization, which is a precursor of infection. Aim To summarize the effect of nasal (± whole-body wash) MRSA decolonization in haemodialysis patients by means of a systematic review and meta-analysis. Methods We identified eligible studies using Medline, Embase, the Cochrane database, clinicaltrials.org , and conference abstracts investigating the success of MRSA decolonization in haemodialysis patients. For the statistical analysis, we used Stata 13 to express study-specific proportions with 95% confidence intervals. A likelihood ratio test was used to assess inter-study heterogeneity. Findings Six published prospective cohort studies and one study described in a conference abstract met our inclusion criteria. From 1150 haemodialysis patients enrolled in these studies, MRSA was isolated from nasal swabs of 147 (12.8%) patients. Six of the trials used mupirocin nasal ointment and combined it with chlorhexidine body washes for decolonization. The most widely used protocol was a five-day course of mupirocin nasal ointment application three times a day, and chlorhexidine body wash once daily. The pooled success rate of decolonization was 0.88 (95% confidence interval: 0.75–0.95). A likelihood ratio test of the fixed versus the random-effects model showed significant inter-study heterogeneity ( P = 0.047). Four of seven studies determined subsequent MRSA infections in 94 carriers overall, two (2%) of which experienced infection. Conclusion The use of mupirocin together with whole-body decolonization is highly effective in eradicating MRSA carriage in haemodialysis patients. The current literature, however, is characterized by a lack of comparative effectiveness studies for this intervention.
Editor: England: Elsevier Ltd
Idioma: Inglês

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Effectiveness of meticillin-resistant Staphylococcus aureus decolonization in long-term haemodialysis patients: a systematic review and meta-analysis

Gebreselassie, H.M ; Lo Priore, E ; Marschall, J

England: Elsevier Ltd

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