Presentation Outline ICHP Annual Meeting September 13-15

Evidence: Inpatient ICU MRSA Colonization -
Infection Control
• Forty-five US hospital currently participating in a cluster
randomized trial
• Prevention of MRSA infection in ICUs
1. Positive screening cultures of ICU admission � contact precaution
2. Positive screening cultures of ICU admission � decolonization
3. Universal decolonization of ICU admission without screening
Platt R et al. Med Care 2010
Evidence: Recurrent Skin and Soft Tissue
Infections – Community-associated MRSA
• Recurrent SSTI despite optimizing wound care/hygiene measures
• Ongoing transmission among household members or close
contacts despite optimizing wound care/hygiene measures
• Decolonization strategies should be offered in conjunction with
ongoing reinforcement of hygiene measures
• Mupirocin twice daily for 5-10 days
• Mupirocin twice daily for 5-10 days and topical body decolonization regimens
with a skin antiseptic solution (eg, chlorhexidine) for 5–14 days or bleach baths
• Evidence: CIII
Liu C, et al. CID 2011
Tenover FC. AAC 2012
Mupirocin Resistance in the US
Evidence: Recurrent Skin Soft Tissue
Infections – Community-associate MRSA
Liu C, et al. CID 2011
Mupirocin for Decolonization
• Clinical and epidemiological outcomes influencing use
– Perioperative eradication of S. aureus colonization
– Controlling for HA-MRSA and transmission
– Incidence of CA-MRSA
• Learning from others
– UK – screening includes all hospital admissions
– Utilizing much more mupirocin
– UK - high-level mupriocin resistance ~ 12%
• MICs >/= 512 mg/mL
• Independently associated with decolonization failure
• Selection of increased drug resistance in S. aureus
– Plasmid carrying resistance determinants to other antimicrobial agents, including
macrolides, gentamicin, tetracycline, and trimethoprim
References
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8/29/2012
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