• Lonneke G M Bode, Miranda M L van Rijen, Heiman F L Wertheim, Christina M J E Vandenbroucke-Grauls, Annet Troelstra, Andreas Voss, Henri A Verbrugh, Margreet C Vos, and Jan A J W Kluytmans.
• *Erasmus University Medical Center, Department of Medical Microbiology and Infectious Diseases, Rotterdam, The Netherlands †Amphia Hospital, Laboratory for Microbiology and Infection Control, Breda, The Netherlands ‡VU Medical Center, Department of Medical Microbiology and Infection Control, Amsterdam, The Netherlands §University Medical Center, Department of Medical Microbiology, Utrecht, The Netherlands ¶Canisius Wilhelmina Hospital/Sint Maartenskliniek, Department of Medical Microbiology and Infectious Diseases, Nijmegen, The Netherlands.
• Ann. Surg. 2016 Mar 1; 263 (3): 511-5.

ObjectiveTo identify patients who benefit most from Staphylococcus aureus screening and decolonization treatment upon admission.BackgroundS. 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.MethodsThree 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.ResultsAfter 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)].ConclusionsDetection 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.

25 keywords...

hide…