title: The effect of targeted decolonization on methicillin-resistant Staphylococcus aureus colonization or infection in a surgical intensive care unit.
abstract: The effect of decolonization on the control of methicillin-resistant Staphylococcus aureus (MRSA) may differ depending on intensive care unit (ICU) settings and the prevalence of antiseptic resistance in MRSA.
  
  
  
  This study was conducted in a 14-bed surgical ICU over a 40-month period. The baseline period featured active surveillance for MRSA and institution of contact precautions. MRSA decolonization via chlorhexidine baths and intranasal mupirocin was implemented during a subsequent 20-month intervention period. Pre-post and interrupted time series analysis were used to evaluate changes in the clinical incidence of hospital-acquired MRSA colonization or infection. MRSA isolates were tested for the presence of qacA/B genes and mupirocin resistance.
  
  
  
  In pre-post analysis, the clinical incidence of MRSA significantly decreased by 61.6% after implementation of decolonization (P < .001). Meanwhile, interrupted time series analysis showed decreases in both the level (β = -0.686; P = .210) and trend (β = -0.011; P = .819) of clinical MRSA incidence, but these changes were not statistically significant. Of 169 MRSA isolates, 64 (37.8%) carried the qacA/B genes, and 22 (13.0%) showed either low- (n = 20) or high-level (n = 2) resistance to mupirocin. Low-level mupirocin resistance significantly increased from 0%-19.4% during the study period.
  
  
  
  Although decolonization using antiseptic agents was helpful to decrease hospital-acquired MRSA rates, the emergence of antiseptic resistance should be monitored.
authors: Division of Infectious Diseases, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, JinJu, Republic of Korea; Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, JinJu, Republic of Korea.
authors: Oh-Hyun
authors: OH
authors: Cho
authors: Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, JinJu, Republic of Korea.
authors: Eun Hwa
authors: EH
authors: Baek
authors: Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, JinJu, Republic of Korea.
authors: Mi Hui
authors: MH
authors: Bak
authors: Infection Control Office, Gyeongsang National University Hospital, JinJu, Republic of Korea.
authors: Young Sun
authors: YS
authors: Suh
authors: Department of Laboratory Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, JinJu, Republic of Korea.
authors: Ki-Ho
authors: KH
authors: Park
authors: Gyeongsang Institute of Health Sciences, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, JinJu, Republic of Korea; Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea.
authors: Sunjoo
authors: S
authors: Kim
authors: Division of Infectious Diseases, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, JinJu, Republic of Korea; Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, JinJu, Republic of Korea; Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea.
authors: In-Gyu
authors: IG
authors: Bae
authors: Division of Infectious Diseases, Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea. Electronic address: zzanmery@gmail.com.
authors: Sun Hee
authors: SH
authors: Lee
mesh_terms: D000281:Administration, Intranasal; D000368:Aged; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage; D001494:Baths; D002353:Carrier State / Q000188:drug therapy* / Q000382:microbiology; D002710:Chlorhexidine / Q000008:administration & dosage; D003422:Critical Care; D003428:Cross Infection / Q000517:prevention & control; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D065186:Interrupted Time Series Analysis; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D016712:Mupirocin / Q000008:administration & dosage; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology
chemical_list: D000891:Anti-Infective Agents, Local; D016712:Mupirocin; D002710:Chlorhexidine
keywords: Chlorhexidine; Infection control; Mupirocin