Archive for November 10th, 2009
Effects of Preoperative Skin Preparation on Postoperative Wound Infection Rates: A Prospective Study of 3 Skin Preparation Protocols
Infection Control and Hospital Epidemiology October 2009 V.30 N.10 p.964–971
Brian R. Swenson, MD, MS; Traci L. Hedrick, MD; Rosemarie Metzger, MD; Hugo Bonatti, MD; Timothy L. Pruett, MD; Robert G. Sawyer, MD
From the Departments of Surgery (B.R.S., T.L.H., R.M., H.B., T.L.P., R.G.S.) and Public Health Sciences (R.G.S.), University of Virginia Health System, Charlottesville.
Objective. To compare the effects of different skin preparation solutions on surgical-site infection rates.
Design. Three skin preparations were compared by means of a sequential implementation design. Each agent was adopted as the preferred modality for a 6-month period for all general surgery cases. Period 1 used a povidone-iodine scrub-paint combination (Betadine) with an isopropyl alcohol application between these steps, period 2 used 2% chlorhexidine and 70% isopropyl alcohol (ChloraPrep), and period 3 used iodine povacrylex in isopropyl alcohol (DuraPrep). Surgical-site infections were tracked for 30 days as part of ongoing data collection for the National Surgical Quality Improvement Project initiative. The primary outcome was the overall rate of surgical-site infection by 6-month period performed in an intent-to-treat manner.
Setting. Single large academic medical center.
Patients. All adult general surgery patients.
Results. The study comprised 3,209 operations. The lowest infection rate was seen in period 3, with iodine povacrylex in isopropyl alcohol as the preferred preparation method (3.9%, compared with 6.4% for period 1 and 7.1% for period 2; ). In subgroup analysis, no difference in outcomes was seen between patients prepared with povidone-iodine scrub-paint and those prepared with iodine povacrylex in isopropyl alcohol, but patients in both these groups had significantly lower surgical-site infection rates, compared with rates for patients prepared with 2% chlorhexidine and 70% isopropyl alcohol (4.8% vs 8.2%; ).
Conclusions. Skin preparation solution is an important factor in the prevention of surgical-site infections. Iodophor-based compounds may be superior to chlorhexidine for this purpose in general surgery patients.
Abstract
Add comment November 10, 2009
Long-term follow-up trial of oral rifampin-cotrimoxazole combination versus intravenous cloxacillin in treatment of chronic staphylococcal osteomyelitis.
Antimicrob Agents Chemother. 2009 Jun. V.53 N.6 p.2672-2676.
G. Euba,1* O. Murillo,1 N. Fernández-Sabé,1 J. Mascaró,1, J. Cabo,2 A. Pérez,2 F. Tubau,3 R. Verdaguer,3 F. Gudiol,1 and J. Ariza1
Infectious Diseases Department,1 Orthopedic Surgery Department,2 Microbiology Department, IDIBELL, Hospital Universitari de Bellvitge, Barcelona, Spain3
Oral therapies alternative to fluoroquinolones against staphylococcal chronic osteomyelitis have not been evaluated in comparative studies. Consecutive nonaxial Staphylococcus aureus chronic osteomyelitis cases were included in a comparative trial after debridement. Fifty patients were randomized: group A (n = 22) was treated with cloxacillin for 6 weeks intravenously plus 2 weeks orally (p.o.), and group B (n = 28) was treated with rifampin-cotrimoxazole for 8 weeks p.o. During follow-up (10 years), five relapses occurred: two (10%) in group A and three (11%) in group B. Foreign-body maintenance was associated with relapse (P = 0.016). Oral rifampin-cotrimoxazole treatment showed outcomes comparable to those for intravenous cloxacillin treatment.
Add comment November 10, 2009
Efficacy of daptomycin in implant-associated infection due to methicillin-resistant Staphylococcus aureus: importance of combination with rifampin.
Antimicrob Agents Chemother. 2009 Jul. V.53 N.7 p.2719-2724.
Anne-Kathrin John,1 Daniela Baldoni,1 Manuel Haschke,2 Katharina Rentsch,3 Patrick Schaerli,4 Werner Zimmerli,5 and Andrej Trampuz1,6*
Infectious Diseases, Department of Biomedicine, University Hospital Basel, Basel, Switzerland,1 Division of Clinical Pharmacology and Toxicology, University Hospital Basel, Basel, Switzerland,2 Institute of Clinical Chemistry, University Hospital Zurich, Zurich, Switzerland,3 Infectious Diseases, Transplantation and Immunology, Novartis Pharma Schweiz AG, Bern, Switzerland,4 Basel University Medical Clinic, Kantonsspital, Liestal, Switzerland,5 Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland6
Limited treatment options are available for implant-associated infections caused by methicillin (meticillin)-resistant Staphylococcus aureus (MRSA). We compared the activity of daptomycin (alone and with rifampin [rifampicin]) with the activities of other antimicrobial regimens against MRSA ATCC 43300 in the guinea pig foreign-body infection model. The daptomycin MIC and the minimum bactericidal concentration in logarithmic phase and stationary growth phase of MRSA were 0.625, 0.625, and 20 µg/ml, respectively. In time-kill studies, daptomycin showed rapid and concentration-dependent killing of MRSA in stationary growth phase. At concentrations above 20 µg/ml, daptomycin reduced the counts by >3 log10 CFU/ml in 2 to 4 h. In sterile cage fluid, daptomycin peak concentrations of 23.1, 46.3, and 53.7 µg/ml were reached 4 to 6 h after the administration of single intraperitoneal doses of 20, 30, and 40 mg/kg of body weight, respectively. In treatment studies, daptomycin alone reduced the planktonic MRSA counts by 0.3 log10 CFU/ml, whereas in combination with rifampin, a reduction in the counts of >6 log10 CFU/ml was observed. Vancomycin and daptomycin (at both doses) were unable to cure any cage-associated infection when they were given as
monotherapy, whereas rifampin alone cured the infections in 33% of the cages. In combination with rifampin, daptomycin showed cure rates of 25% (at 20 mg/kg) and 67% (at 30 mg/kg), vancomycin showed a cure rate of 8%, linezolid showed a cure rate of 0%, and levofloxacin showed a cure rate of 58%. In addition, daptomycin at a high dose (30 mg/kg) completely prevented the emergence of rifampin resistance in planktonic and adherent MRSA cells. Daptomycin at a high dose, corresponding to 6 mg/kg in humans, in combination with rifampin showed the highest activity against planktonic and adherent MRSA. Daptomycin plus rifampin is a promising treatment option for implant-associated MRSA infections.
Add comment November 10, 2009
