New approaches to prevention of staphylococcal infection in surgery.
OBJECTIVE
The present review describes the literature about the prevention of Staphylococcus aureus infections in surgery, published from August 2006 to January 2008, and puts it into perspective.


RESULTS
To prevent Staphylococcus aureus infections after surgical procedures, three methods were described, that is, isolation precautions after methicillin-resistant Staphylococcus aureus screening, vancomycin as an antibiotic prophylaxis in patients at risk for methicillin-resistant Staphylococcus aureus, and topical decolonization of carriage. Identified methicillin-resistant Staphylococcus aureus carriers can be treated with the appropriate antibiotic prophylaxis to prevent infection with methicillin-resistant Staphylococcus aureus. Topical decolonization with chlorhexidine gluconate resulted in a reduced overall nosocomial infection rate, but no effect was found on the Staphylococcus aureus infection rate. Topical decolonization with mupirocin reduced the overall Staphylococcus aureus infection rate after surgery in Staphylococcus aureus nasal carriers.


CONCLUSIONS
The treatment of proven carriers of Staphylococcus aureus with mupirocin is an effective method to prevent Staphylococcus aureus nosocomial infections after surgery. Cost-analysis studies show that this screen-and-treat approach is cost saving as long as the prevalence of mupirocin resistance in Staphylococcus aureus is low. The effect of chlorhexidine gluconate on the Staphylococcus aureus infection rate in carriers should be determined in future studies.
van Rijen
Miranda Ml
MM
Laboratory for Microbiology and Infection Control, Amphia Hospital, Breda, The Netherlands. mvrijen@amphia.nl
Kluytmans
Jan A J W
JA
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D002353:Carrier State / Q000188:drug therapy; D018890:Chemoprevention; D002710:Chlorhexidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D003428:Cross Infection / Q000517:prevention & control*; D006801:Humans; D016712:Mupirocin / Q000627:therapeutic use; D010356:Patient Isolation; D013203:Staphylococcal Infections / Q000517:prevention & control*; D013530:Surgical Wound Infection / Q000517:prevention & control*; D014640:Vancomycin / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D014640:Vancomycin; D016712:Mupirocin; C010882:chlorhexidine gluconate; D002710:Chlorhexidine