Efficacy and Limitation of a Chlorhexidine-Based Decolonization Strategy in Preventing Transmission of Methicillin-Resistant Staphylococcus aureus in an Intensive Care Unit

December 31, 2009 at 11:19 am Leave a comment

Clinical Infectious Diseases  15 January 2010  V.50  N.2  p.210–217

Rahul Batra,1 Ben S. Cooper,5,6 Craig Whiteley,2 Amita K. Patel,1 Duncan Wyncoll,2 and Jonathan D. Edgeworth1,3

1Directorate of Infection and 2Intensive Care Unit, Guy’s and St Thomas’ National Health Service Foundation Trust, and 3Department of Infectious Diseases, King’s College London School of Medicine at Guy’s, King’s College, and St Thomas’ Hospitals, London, and 4Center for Clinical Vaccinology and Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom; and 5Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand

Background.Surface-active antiseptics, such as chlorhexidine, are increasingly being used as part of intervention programs to prevent methicillin-resistant Staphylococcus aureus (MRSA) transmission, despite limited evidence and potential for resistance. We report on the effect of an antiseptic protocol on acquisition of both endemic MRSA and an outbreak strain of MRSA sequence type 239 (designated TW).

Methods.Interrupted time-series data on MRSA acquisitions in two 15-bed intensive care units were analyzed using segmented regression models to estimate the effects of sequential introduction of an educational campaign, cohorting, and a chlorhexidine-based antiseptic protocol on transmission of TW and non-TW MRSA strains. Representative TW and non-TW MRSA strains were assessed for carriage of qacA/B genes and antiseptic susceptibility.

Results.The antiseptic protocol was associated with a highly significant, immediate 70% reduction in acquisition of non-TW MRSA strains (estimated model-averaged incidence rate ratio, 0.3; 95% confidence interval, 0.19–0.47) and an increase in acquisition of TW MRSA strains (estimated model-averaged incidence rate ratio, 3.85; 95% confidence interval, 0.80–18.59). There was only weak evidence of an effect of other interventions on MRSA transmission. All TW MRSA strains (21 of 21 isolates) and <5% (1 of 21 isolates) of non-TW MRSA strains tested carried the chlorhexidine resistance loci qacA/B. In vitro chlorhexidine minimum bactericidal concentrations of TW strains were 3-fold higher than those of non-TW MRSA strains, and in vivo, only patients with non-TW MRSA demonstrated a reduction in the number of colonization sites in response to chlorhexidine treatment.

Conclusion.A chlorhexidine-based surface antiseptic protocol can interrupt transmission of MRSA in the intensive care unit, but strains carrying qacA/B genes may be unaffected or potentially spread more rapidly.





EDITORIAL  p.218–220

Prevention and Control of Methicillin-Resistant Staphylococcus aureus: Dealing With Reality, Resistance, and Resistance to Reality

William R. Jarvis

Jason and Jarvis Associates, Hilton Head, South Carolina





Entry filed under: Bacterias, Desinfection and Sterilization, Infecciones nosocomiales.

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