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Discontinuing contact precautions for multidrug-resistant organisms: A systematic literature review and meta-analysis.

Marra AR, Edmond MB, Schweizer ML, Ryan GW, Diekema DJ. Discontinuing contact precautions for multidrug-resistant organisms: A systematic literature review and meta-analysis. American journal of infection control. 2018 Mar 1; 46(3):333-340.

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Abstract:

BACKGROUND: Several single-center studies have suggested that eliminating contact precautions (CPs) for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) control in nonoutbreak settings has no impact on infection rates. We performed a systematic literature review and meta-analysis on the impact of discontinuing contact precautions in the acute care setting. METHODS: We searched PubMed, CINAHL, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, and Embase through December 2016 for studies evaluating discontinuation of contact precautions for multidrug-resistant organisms. We used random-effect models to obtain pooled risk ratio estimates. Heterogeneity was evaluated with I estimation and the Cochran Q statistic. Pooled risk ratios for MRSA and VRE were assessed separately. RESULTS: Fourteen studies met inclusion criteria and were included in the final review. Six studies discontinued CPs for both MRSA and VRE, 3 for MRSA only, 2 for VRE only, 2 for extended-spectrum ß-lactamase-producing Escherichia coli, and 1 for Clostridium difficile infection. When study results were pooled, there was a trend toward reduction of MRSA infection after discontinuing CPs (pooled risk ratio, 0.84; 95% confidence interval, 0.70-1.02; P? = .07) and a statistically significant reduction in VRE infection (pooled risk ratio, 0.82; 95% confidence interval, 0.72-0.94; P? = .005). CONCLUSIONS: Discontinuation of CPs for MRSA and VRE has not been associated with increased infection rates.





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