Background: This study was performed to evaluate the effectiveness of surveillance for screening and treatment of\npatients with chronic kidney disease undergoing hemodialysis and colonized by Staphylococcus aureus.\nMethods: A systematic review and meta-analysis were performed. The literature search involved the following\ndatabases: the Cochrane Controlled Trials Register, Embase, LILACS, CINAHL, SciELO, and PubMed/Medline. The\ndescriptors were ââ?¬Å?Staphylococcus aureusââ?¬Â, ââ?¬Å?MRSAââ?¬Â, ââ?¬Å?MSSAââ?¬Â, ââ?¬Å?treatmentââ?¬Â, ââ?¬Å?decolonizationââ?¬Â, ââ?¬Å?nasal carrierââ?¬Â, ââ?¬Å?colonizationââ?¬Â,\nââ?¬Å?chronic kidney diseaseââ?¬Â, ââ?¬Å?dialysisââ?¬Â, and ââ?¬Å?haemodialysisââ?¬Â or ââ?¬Å?hemodialysisââ?¬Â. Five randomized controlled trials that\nexhibited agreement among reviewers as shown by a kappa value of >0.80 were included in the study; methodological\nquality was evaluated using the STROBE statement. Patients who received various treatments (various treatments\ngroup) or topical mupirocin (mupirocin group) were compared with those who received either no treatment or\nplacebo (control group). The outcomes were skin infection at the central venous catheter insertion site and bacteremia.\nResults: In total, 2374 patients were included in the analysis, 626 (26.4%) of whom were nasal carriers of S. aureus. The\nprobability of S. aureus infection at the catheter site for hemodialysis was 87% lower in the mupirocin group than in\nthe control group (odds ratio [OR], 0.13; 95% confidence interval [CI], 0.05ââ?¬â??0.34; p < 0.001). The risk of bacteremia was\n82% lower in the mupirocin group than in the control group (OR, 0.18; 95% CI, 0.08ââ?¬â??0.42; p < 0.001). No statistically\nsignificant difference in bacteremia was observed between the various treatments group (excluding mupirocin) and\nthe control group (OR, 0.77; 95% CI, 0.51ââ?¬â??1.15; p = 0.20).\nConclusions: Twenty-six percent of patients undergoing hemodialysis were nasal carriers of S. aureus. Of all treatments\nevaluated, topical mupirocin was the most effective therapy for the reduction of S. aureus catheter site infection and\nbacteremia in patients undergoing chronic hemodialysis.
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