Effectiveness of meticillin-resistant Staphylococcus aureus decolonization in long-term haemodialysis patients: a systematic review and meta-analysis. Issue 3 (November 2015)

• Record Type: Journal Article
• Authors: Gebreselassie, H.M.; Lo Priore, E.; Marschall, J.
• Is Part Of: Journal of hospital infection. Volume 91:Issue 3(2015)
• Page Start: 250
• Page End: 256
• Publication Date: 2015-11
• Subjects: Cross infection -- Periodicals; Cross infection -- Prevention -- Periodicals; Nosocomial infections -- Periodicals; Nosocomial infections -- Prevention -- Periodicals; Cross Infection -- Periodicals; Cross Infection -- prevention & control -- Periodicals; Infection Control -- Periodicals; Electronic journals; 614.44
• DOI: 10.1016/j.jhin.2015.08.015
• Languages: English
• ISSNs: 0195-6701

Abstract

<abstract xml:lang="en" abstract-type="author" id="abs0010"> <title id="sectitle0010">Summary</title> <sec> <title id="sectitle0015">Background</title> <p id="abspara0010">Chronic haemodialysis patients are a high-risk population for meticillin-resistant <italic>Staphylococcus aureus</italic> (MRSA) colonization, which is a precursor of infection.</p> </sec> <sec> <title id="sectitle0020">Aim</title> <p id="abspara0015">To summarize the effect of nasal (± whole-body wash) MRSA decolonization in haemodialysis patients by means of a systematic review and meta-analysis.</p> </sec> <sec> <title id="sectitle0025">Methods</title> <p id="abspara0020">We identified eligible studies using Medline, Embase, the Cochrane database, <ext-link ext-link-type="unknown" id="intref0010" xlink:type="simple" xlink:href="http://clinicaltrials.org" xmlns:xlink="http://www.w3.org/1999/xlink">clinicaltrials.org</ext-link>, 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.</p> </sec> <sec> <title id="sectitle0030">Findings</title> <p id="abspara0025">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 (<italic>P</italic> = 0.047). Four of seven studies determined subsequent MRSA infections in 94 carriers overall, two (2%) of which experienced infection.</p> </sec> <sec> <title id="sectitle0035">Conclusion</title> <p id="abspara0030">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.</p> </sec> </abstract>