Acute Management of Open Fractures: An Evidence-Based Review.

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Abstract

[Indexed for MEDLINE] 5. Clin Microbiol Infect. 2024 Dec;30(12):1537-1550. doi: 10.1016/j.cmi.2024.07.012. Epub 2024 Aug 21. European Society of Clinical Microbiology and Infectious Diseases/European Committee on infection control clinical guidelines on pre-operative decolonization and targeted prophylaxis in patients colonized by multidrug-resistant Gram-positive bacteria before surgery. Righi E(1), Mutters NT(2), Guirao X(3), Dolores Del Toro M(4), Eckmann C(5), Friedrich AW(6), Giannella M(7), Presterl E(8), Christaki E(9), Cross ELA(10), Visentin A(1), Sganga G(11), Tsioutis C(12), Tacconelli E(1), Kluytmans J(13). Author information: (1)Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy. (2)University Hospital Bonn, Institute for Hygiene and Public Health, Bonn, Germany. (3)Department of General Surgery, Surgical Endocrine Unit, Surgical Site Prevention Unit, Consorci Corporació Sanitària Parc Tauli, Sabadell, Spain. (4)Division of Infectious Diseases and Microbiology, University Hospital Virgen Macarena, Seville, Spain; Department of Medicine, University of Sevilla, Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain. (5)Department of Klinikum Hannoversch-Muenden, Academic Hospital of Goettingen University, Göttingen, Germany. (6)University Hospital Münster, Münster, Germany. (7)Department of Infectious Diseases Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. (8)Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Vienna, Austria (on behalf of the ESCMID Study Group on Nosocomial Infections - ESGNI), Austria. (9)Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece. (10)Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, United Kingdom. (11)Department of Emergency Surgery and Trauma, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Del Sacro Cuore, Rome, Italy. (12)School of Medicine, European University Cyprus, Nicosia, Cyprus. (13)Department of Medical Microbiology, University Medical Center Utrecht, Utrecht University, The Netherlands. Electronic address: j.a.j.kluijtmans@umcutrecht.nl. SCOPE: The aim of these guidelines is to provide recommendations for decolonization and perioperative antibiotic prophylaxis (PAP) in multidrug-resistant Gram-positive bacteria (MDR-GPB) adult carriers before inpatient surgery. METHODS: These European Society of Clinical Microbiology and Infectious Diseases/European Committee on Infection Control guidelines were developed following a systematic review of published studies targeting methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci, methicillin-resistant coagulase-negative Staphylococci, and pan-drug-resistant-GPB. Critical outcomes were the occurrence of surgical site infections (SSIs) caused by the colonizing MDR-GPB and SSIs-attributable mortality. Important outcomes included the occurrence of SSIs caused by any pathogen, hospital-acquired infections, all-cause mortality, and adverse events associated with the interventions, including resistance development to the agents used and the incidence of Clostridioides difficile infections. The last search of all databases was performed on 1 November 2023. The level of evidence and the strength of each recommendation were defined according to the Grading of Recommendations Assessment, Development, and Evaluation approach. Consensus of a multidisciplinary expert panel was reached for the final list of recommendations. Antimicrobial stewardship considerations were included. RECOMMENDATIONS: The guideline panel reviewed the impact of decolonization, targeted PAP, and combined interventions (e.g. decolonization and targeted PAP) on the risk of SSIs and other outcomes in MDR-GPB carriers, according to the type of bacteria and type of surgery. We recommend screening for S. aureus before high-risk operations, such as cardiothoracic and orthopaedic surgery. Decolonization with intranasal mupirocin with or without a chlorhexidine bath is recommended in patients colonized with S. aureus before cardiothoracic and orthopaedic surgery and suggested in other surgeries. The addition of vancomycin to standard prophylaxis is suggested for MRSA carriers in cardiothoracic surgery, orthopaedic surgery, and neurosurgery. Combined interventions (e.g. decolonization and targeted prophylaxis) are suggested for MRSA carriers undergoing cardiothoracic and orthopaedic surgery. No recommendation could be made regarding screening, decolonization and targeted prophylaxis for vancomycin-resistant enterococci because of the lack of data. No evidence was retrieved for methicillin-resistant coagulase-negative Staphylococci and pan-drug-resistant-GPB. Careful consideration of the laboratory workload and involvement of antimicrobial stewardship and infection control teams are warranted before implementing screening procedures or performing changes in PAP policy. Future research should focus on novel decolonizing techniques, on the monitoring of resistance to decolonizing agents and PAP regimens, and on standardized combined interventions in high-quality studies. Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved. DOI: 10.1016/j.cmi.2024.07.012