Nasal decolonization: What antimicrobials and antiseptics are most effective before surgery and in the ICU

莫匹罗星 医学 重症监护医学 入射(几何) 随机对照试验 重症监护室 金黄色葡萄球菌 感染控制 外科 骨科手术 临床试验 内科学 耐甲氧西林金黄色葡萄球菌 物理 光学 细菌 生物 遗传学
作者
Matthew Smith,Loreen A. Herwaldt
出处
期刊:American Journal of Infection Control [Elsevier]
卷期号:51 (11): A64-A71 被引量:8
标识
DOI:10.1016/j.ajic.2023.02.004
摘要

•Intranasal mupirocin is effective pre-operatively for orthopedic and cardiac procedures.•Mupirocin is effective for nasal decolonization in the intensive care unit setting.•Intranasal povidone-iodine is most effective for pre-operative nasal decolonization.•Other decolonization agents lack sufficient data for widespread use.•Additional research on decolonizing agents is still needed. BackgroundStaphylococcus aureus colonization is a key risk factor for S. aureus infections in surgical patients and in hospitalized patients. Many studies have assessed various decolonization agents, protocols, and settings. This review summarizes key findings about nasal decolonization for 2 different patient populations: patients undergoing surgery and patients hospitalized in intensive care units.MethodsWe reviewed major studies related to decolonization of patients colonized with S. aureus and who were either undergoing surgical procedures or were hospitalized in intensive care units. We focused on recent studies, particularly randomized controlled trials and robust quasi-experimental trials. We also reviewed select non-randomized trials when more rigorous trials were limited.Discussion/ConclusionsMupirocin is the best-studied agent for decolonization. Its use reduces the risk of surgical site infection following orthopedic surgery (strongest data) and cardiac surgery. Mupirocin decolonization also reduces the incidence of S. aureus clinical cultures in the intensive care unit. Povidone-iodine is less well-studied. Current data suggest that it decreases the risk of surgical site infections after orthopedic surgical procedures. In contrast, povidone-iodine is less effective than mupirocin for reducing the incidence of S aureus clinical cultures in the intensive care unit. Both mupirocin and povidone-iodine have important limitations, highlighting the need for future decolonization research. Staphylococcus aureus colonization is a key risk factor for S. aureus infections in surgical patients and in hospitalized patients. Many studies have assessed various decolonization agents, protocols, and settings. This review summarizes key findings about nasal decolonization for 2 different patient populations: patients undergoing surgery and patients hospitalized in intensive care units. We reviewed major studies related to decolonization of patients colonized with S. aureus and who were either undergoing surgical procedures or were hospitalized in intensive care units. We focused on recent studies, particularly randomized controlled trials and robust quasi-experimental trials. We also reviewed select non-randomized trials when more rigorous trials were limited. Mupirocin is the best-studied agent for decolonization. Its use reduces the risk of surgical site infection following orthopedic surgery (strongest data) and cardiac surgery. Mupirocin decolonization also reduces the incidence of S. aureus clinical cultures in the intensive care unit. Povidone-iodine is less well-studied. Current data suggest that it decreases the risk of surgical site infections after orthopedic surgical procedures. In contrast, povidone-iodine is less effective than mupirocin for reducing the incidence of S aureus clinical cultures in the intensive care unit. Both mupirocin and povidone-iodine have important limitations, highlighting the need for future decolonization research.
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