Combined Topical and Oral Antimicrobial Therapy for the Eradication of Methicillin‐Resistant Staphylococcus aureus (Mrsa) Colonization in Hospitalized Patients

Abstract

OBJECTIVE: How to eradicate methicillin-resistantStaphylo-coccus aureus(MRSA) colonization in hospitalized patients is uncertain. We reviewed our experience with MRSA decolonization therapy in hospitalized patients.SETTING: An 1100-bed, university-affiliated tertiary care teaching hospital in Toronto, Ontario.DESIGN: Retrospective chart review of 207 adult inpatients with MRSA colonization hospitalized between February 1996 and March 1999.INTERVENTIONS: All patients with MRSA colonization were assessed for possible decolonization therapy with a combination of 4% chlorhexidine soap for bathing and washing, 2% mupirocin ointment applied to the anterior nares three times/day, rifampin (300 mg twice daily) and either trimethoprim/sulfamethoxazole (160 mg/800 mg twice daily) or doxycycline (100 mg twice daily). This treatment was given for seven days.RESULTS: A total of 207 hospitalized patients with MRSA colonization were identified and 103 (50%) received decolonization therapy. Patients who received decolonization therapy were less likely than untreated patientsto have intravenous (P=0.004) or urinary catheters (P<0.001), or extranasal sites of colonization (P=0.001). Successful decolonization was achieved in 90% of the 43 patients who were available for at least three months of follow-up.CONCLUSIONS: Combined topical and oral antimicrobial therapy was found to be effective in eradicating MRSA colonization in selected hospitalized patients, especially those without indwelling medical devices or extranasal sites of colonization.

Decolonization of Methicillin‐Resistant Staphylococcus aureus during Routine Hospital Care: Efficacy and Long‐Term Follow‐Up

“…Many previous studies (13)(14)(15)(16)(17)(18)20,21) investigating MRSA decolonization strategies have been compromised by small sample size, tendency to exclude patients with multiple indwelling catheters and limited follow-up. The present study highlights the fact that even in a relatively unselected cohort, the mean duration of successful decolonization exceeded one year.…”

“…A recent Cochrane collaboration review (13) of six randomized controlled trials studying MRSA decolonization concluded that there was insufficient evidence to support the use of decolonization. Despite these data, decolonization in selected patients is frequently performed in many hospitals (14).…”

Successful Treatment for Carriage of Methicillin-Resistant Staphylococcus aureus and Importance of Follow-Up

“…Failure of MRSA eradication therapy has often been attributed to colonization of extranasal sites (2,17,20). No consensus exists regarding the number of follow-up cultures that should be obtained after MRSA eradication therapy to assess the success of treatment.…”

Le Staphylococcus aureus méthicillinorésistant d’origine non nosocomiale dans les communautés autochtones du Canada

“…• The recommended regimen for nasal decolonization for mupirocin-susceptible isolates is mupirocin ointment to the nares twice daily for five to 10 days (133,134,140).…”

“…• A combined strategy of intranasal mupirocin, topical antiseptics and systemic antibiotics (active against the colonizing strain and achieving high levels in body secretions [eg, rifampin or clindamycin]) may be considered (140). (BIII) 8.0 POPULATION SURVEILLANCE 8.1 Population surveillance program for CA-MRSA The Working Group meeting identified several possible purposes of a population surveillance program: to document the emergence of resistance to methicillin among community isolates of S aureus to inform empirical therapy; to describe the occurrence and impact of severe S aureus disease in a community, irrespective of resistance pattern; and to facilitate timely identification of potential outbreaks.…”