Use this URL to cite or link to this record in EThOS: https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.762730
Title: Enteral vancomycin to control severe methicillin-resistant Staphylococcus aureus infections in the intensive care unit
Author: Silvestri, Luciano
ISNI:       0000 0001 2242 4697
Awarding Body: University of Liverpool
Current Institution: University of Liverpool
Date of Award: 2018
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Abstract:
Background: Oropharyngeal chlorhexidine and mupirocin have been used in the intensive care unit (ICU) to control lower respiratory tract infection, including methicillin-resistant Staphylococcus aureus (MRSA) infection. The use of enteral vancomycin to control MRSA carriage of the oropharynx and the gut and to prevent MRSA infection of the lower airways and the bloodstream is a promising manoeuvre. Aims of the research: 1. To assess the effectiveness of oropharyngeal mupirocin and chlorhexidine to control severe ICU infection, including MRSA infection; 2. To assess the effectiveness of enteral vancomycin to control MRSA infection in the ICU, and to assess the safety of the manoeuvre, i.e. emergence of vancomycinintermediate Staphylococcus aureus (VISA) and vancomycin-resistant enterococci (VRE); 3. To undertake a cohort study in the ICU in order to evaluate the impact of topical oropharyngeal vancomycin on MRSA infection and on the emergence of VISA and VRE. Design of the research: Systematic review and meta-analysis of randomised studies for point 1; systematic review and meta-analysis of randomised and non-randomised studies for point 2; observational retrospective study for point 3. Results: The systematic review and meta-analysis showed that mupirocin and chlorhexidine reduced lower respiratory tract infection, but did not demonstrate any impact on MRSA infection and mortality in critically ill ICU patients. The systematic review and meta-analysis of the effectiveness of enteral vancomycin demonstrated a reduction in overall infection rates (Odds Ratio [OR] 0.35, 95% confidence interval [CI] 0.24-0.50, p=0.00199), Staphylococcus aureus carriage (OR 0.03, 95% CI 0.01-0.17, p < 0.001) and infection (OR 0.21, 95% CI 0.15-0.32, p < 0.001). MRSA carriage, MRSA infection, and mortality were reduced by enteral vancomycin (OR 0.15, 95% CI 0.09-0.25, p < 0.001, OR 0.24, 95% CI 0.12-0.50, p < 0.001, and 95% CI 0.43-0.79, p < 0.001, respectively). VISA and VRE were not a clinical problem. The 16-year retrospective study showed that, in patients receiving oropharyngeal vancomycin, MRSA secondary endogenous infections were significantly reduced compared with patients who did not receive enteral vancomycin (OR 0.26 95% CI 0.1-0.69, p=0.007). VISA and VRE were not demonstrated. Conclusions: Oropharyngeal mupirocin and chlorhexidine did not demonstrate any effect on MRSA infection and mortality in systematic review. The use of enteral vancomycin may be an effective strategy to reduce MRSA carriage and infection in ICU patient. The manoeuvre is safe in terms of emergence of VISA and VRE.
Supervisor: Jackson, Malcolm ; Van Saene, H. K. F. Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID: uk.bl.ethos.762730  DOI:
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