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Massive study yields answers on MRSA prevention

NEWS IN BRIEF — Posted June 10, 2013

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Bathing all intensive care unit patients with chlorhexidine soap and applying the antibiotic ointment mupirocin is a much more effective way of preventing methicillin-resistant Staphylococcus aureus infections than the typical practice of screening patients for MRSA and then taking infection-control measures, said a cluster-randomized trial of nearly 75,000 patients at 75 ICUs across the country.

This “universal decolonization” approach lowered the odds of MRSA bloodstream infections by 44% and also cut the risk of positive MRSA clinical cultures by about 30%, said the study, published online May 29 in The New England Journal of Medicine (link).

“This study helps answer a long-standing debate in the medical field about whether we should tailor our efforts to prevent infection to specific pathogens, such as MRSA, or whether we should identify a high-risk patient group and give them all special treatment to prevent infection,” said Susan Huang, MD, MPH, the study’s lead author and medical director of epidemiology and infection prevention at University of California Irvine Health in Orange County. “The universal decolonization strategy was the most effective and the easiest to implement. It eliminates the need for screening ICU patients for MRSA.”

In addition to potentially overturning current practice, however, the study makes recommendations counter to laws in some areas. Nine states mandate MRSA screening of inpatients. In an accompanying editorial, two infectious diseases specialists at the Virginia Commonwealth University School of Medicine said the study should prompt hospitals to stop screening all patients for MRSA and requiring contact precautions for health professionals caring for those who test positive. Physicians and hospitals should be cautious about using mupirocin in a widespread fashion that could exacerbate bacterial resistance to the antibiotic, wrote the editorial’s authors, Michael B. Edmond, MD, MPH, and Richard P. Wenzel, MD (link).

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