USA Invasive i e serious MRSA infections occur
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חומרת המחלה והשלכותיה • זיהום פצע ניתוחי יכול להתפתח החל מזיהום . פשוט דרך ספסיס וכלה במוות . • השלכות כלכליות כמו הארכת משך אשפוז • USA: Invasive (i. e. , serious) MRSA infections occur in approximately 94, 000 persons each year and are associated with approximately 19, 000 deaths. Klevens et al. Journal of the American Medical Association 2007; 298(15): 1763 -1771
MUPIROCIN - Eradication of carriage קונטמינציה של - • האנטיביוטיקה יעילה בדה : דוגמאות. Aureus. S Nasal carriage of S. aureus eliminated in 83. 4% v. 27. 4% in placebo (p<0. 001) Intranasal Mupirocin to Prevent Postoperative Staphylococcus aureus Infections N Engl J Med 2002; 346: 1871
MUPIROCIN – Reduction of post operative S. aureus infections- carriers mupirocin without treatment Relative Risk 95% CI S. aureus infections 25 / 686 46 / 686 0. 55 0. 34– 0. 89 S. aureus Surgical Site Infection 24 / 688 38 / 686 0. 64 0. 38– 1. 06 Intranasal mupirocin for reduction of Staphylococcus aureus infections in surgical patients with nasal carriage: a systematic review Journal of Antimicrobial Chemotherapy (2008) 61, 254– 261
MUPIROCIN – Reduction of post operative S. aureus infections- All patients Among S. aureus carriers mupirocin without treatment Relative Risk 95% CI 25 / 686 46 / 686 0. 55 0. 34– 0. 89 S. aureus infections Intranasal mupirocin for reduction of Staphylococcus aureus infections in surgical patients with nasal carriage: a systematic review Journal of Antimicrobial Chemotherapy (2008) 61, 254– 261 Among All Patients S. aureus infections mupirocin without treatment Relative Risk 95% CI 45 / 1884 55 / 1886 0. 82 Was not computed Intranasal Mupirocin to Prevent Postoperative Staphylococcus aureus Infections N Engl J Med 2002; 346: 1871
MUPIROCIN – Reduction of Death and Nosocomial Infections mupirocin without treatment Relative Risk 95% CI S. aureus infections 25 / 686 46 / 686 0. 55 0. 34– 0. 89 Surgical Site Infection 24 / 688 38 / 686 0. 64 0. 38– 1. 06 1. 05 0. 54 -2. 04 0. 81 Similar Total Nosocomial Infections Death 45 / 1933 55 / 1931 Intranasal mupirocin for reduction of Staphylococcus aureus infections in surgical patients with nasal carriage: a systematic review Journal of Antimicrobial Chemotherapy (2008) 61, 254– 261
MRSA • במחקר מקרה ביקורת נראה קשר של MRSA בין נשאות OR = 65, 95% CI 8. 5– 606 MRSA- לזיהום מ -Systematic Review • SSI- – שוב אין הבדל ב MRSA בגלל SSI – הורדת שיעור – לא נכללו מאמרים לא באנגלית Intranasal mupirocin prophylaxis in elective surgery. A reviewof published studies. Chemotherapy 2008; 54: 9– 16
SSI- לא הוכחה ירידה ב Surgical Site Infection mupirocin without treatment Relative Risk 95% CI 24 / 688 38 / 686 0. 64 0. 38– 1. 06
COST EFFECTIVENESS • לכאורה מראה תועלת 48 -51% • אך מבוססת על הנחת יעילות בטיפול של ? • טיפול למה S. aureus infections mupirocin without treatment Relative Risk 95% CI 25 / 686 46 / 686 0. 55 0. 34– 0. 89 “If this rate was less than 16. 1% (51% in the base-case), the screen-and-treat strategy would no longer be cost-saving… the cost-effectiveness results are highly sensitive to the mupirocin efficacy rate. ” NHS Economic Evaluation Database
. . . חכמים מאיתנו “No recommendation to preoperatively apply mupirocin to nares to prevent SSI. Unresolved issue” GUIDELINE FOR PREVENTION OF SURGICAL SITE INFECTION, 1999