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[Prevention of postoperative infections: patient safety subordinated to antibiotic stewardship]

M J M Bonten1, J Kluytmans

  • 1UMC Utrecht, Julius Centrum voor Gezondheidswetenschappen en Eerstelijns Geneeskunde, Utrecht.

Nederlands Tijdschrift Voor Geneeskunde
|February 24, 2018
PubMed

Insights

A new guideline for surgical antimicrobial prophylaxis targets only Staphylococcus aureus carriers. A universal approach is proposed for cost-effectiveness and to prevent missed carriers, while monitoring resistance.

Area of Science:

  • Infectious Diseases
  • Surgical Prophylaxis
  • Antimicrobial Resistance

Background:

  • Current Dutch guidelines recommend targeted preoperative screening and treatment for Staphylococcus aureus nasal carriers undergoing surgery.
  • This approach involves mupirocin and chlorhexidine showers for identified carriers.
  • Preoperative screening and treatment are often not fully implemented due to infrastructural complexity.

Purpose of the Study:

  • To advocate for a universal treatment approach for surgical antimicrobial prophylaxis.
  • To address the limitations of targeted screening and treatment of Staphylococcus aureus carriers.
  • To propose a more cost-effective strategy that minimizes missed carriers and monitors for resistance.

Main Methods:

  • The study discusses the implications of the current Dutch guideline.
  • It analyzes the challenges in implementing preoperative screening and treatment protocols.
  • It proposes a universal treatment strategy as an alternative.

Main Results:

  • Targeted screening and treatment for Staphylococcus aureus carriers are complex and may not be fully achieved.
  • A universal treatment approach could be more cost-effective.
  • A universal approach can prevent carriers from being missed and allows for monitoring of mupirocin-resistant strains.

Conclusions:

  • A universal surgical antimicrobial prophylaxis approach is recommended over targeted carrier screening.
  • This strategy aims to improve cost-effectiveness and reduce the incidence of missed Staphylococcus aureus carriers.
  • Continuous monitoring for mupirocin-resistant Staphylococcus aureus strains is crucial with a universal approach.

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