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

Abstract

BACkGrounD/oBJECtIvE: Methicillin-resistant Staphylococcus aureus (MRSA) colonization is associated with a significant risk of subsequent MRSA infection in the hospital setting. The use of decolonization as an infection control strategy remains highly controversial despite publications evaluating more than 40 different decolonization regimens over the past 60 years. The present study describes the benefits and potential drawbacks of such an approach in the patient population. MEthoDs: A retrospective cohort study was performed to assess the efficacy and subsequent outcome for patients with newly identified MRSA colonization at the Horizon Health Network in Moncton, New Brunswick. rEsults: A total of 241 patients with MRSA colonization or infection during the study period (2000 to 2005 inclusive) were identified. Eighty-nine MRSA-positive patients were decolonized according to a standardized regimen (hospital protocol group), and 98 received an alternative decolonization regimen (other treatment group). No attempt at decolonization was made for 54 patients (no treatment group). The hospital protocol group demonstrated superior overall successful decolonization compared with the other treatment group (67 of 84 [80%] versus 48 of 89 [54%]; OR 3.3; 95% CI 1.6 to 7.1; P=0.0004) and the no treatment group (four of 43 [9%]; OR 36.9; 95% CI 11.2 to 161.7; P<0.000001). The mean observed duration of culture negativity for the subgroup who remained MRSA culture negative over the long term was 419±398 days (range one to 1817 days). Successful decolonization occurred in 115 patients and permitted subsequent release from contact isolation for 4530 patient-days. The rate of clinical infection with MRSA was significantly lower in the hospital protocol group versus the other treatment group (16 of 89 [18%] versus 37 of 98 [38%]; OR 0.38; 95% CI 0.18 to 0.78; P=0.003). ConClusIon:The present study supports recent reports indicating that MRSA decolonization can be successful using a multifactorial approach (chlorhexidine soap, enhanced hygiene/housekeeping and combination oral/topical antimicrobial therapy) in hospitalized patients, both over the short and long term. Unlike previous studies, decolonization appeared to be effective in a relatively unselected population, including patients with lines and catheters. Inability to decolonize was most closely associated with failure to use a standardized decolonization protocol.

Staphylococcus aureus Colonization among Arthroplasty Patients Previously Treated by a Decolonization Protocol: A Pilot Study

“…This rate is consistent with the only other study in the arthroplasty literature, which demonstrated that 30% of patients decolonized before elective arthroplasty were colonized on subsequent nasal swabbing at a mean of 213 days [11]. This rate is also in general accordance with previous nonarthroplasty population studies revealing persistence after decolonization protocols of approximately 20%-30% [6,22]. Based on these combined data, it is clear that surgeons should not place confidence in a patient's prior colonization status but should retest for colonization at subsequent admissions for surgery as indicated.…”

Panton-Valentine Leukocidin (PVL) genes may not be a reliable marker for community-acquired MRSA in the Dakahlia Governorate, Egypt

“…The strikingly higher incidence of MRSA and PVL -MRSA in HA, CA, and HCWs in this study may be attributed to factors such as the excessive use of antibiotics due to the availability of antibiotics without prescription, the prescription of antibiotics for viral infections, as well as the absence of rapid and accurate methods for identification and decolonization of carries. On the other hand, one of the principal infection control measures for limiting the spread of nosocomial MRSA infection involves the performance of admission screening cultures for MRSA and the isolation of colonized or infected patients [ 37 ]. This protocol does not seem to be strictly implemented in tertiary hospitals of Mansoura.…”

The economic value of personal protective equipment for healthcare workers

“…Our decision model for MRSA assumes effective PPE can reduce the risk of colonization of MRSA, and that a small number of MRSA colonizations will result in fulminant infection, based on literature values. To account for this, we first apply the risk of colonization with adequate or inadequate PPE per encounter, and then subsequently apply the risk of infection given one is colonized [ 31 ]. Most infections result in a full recovery, although a small proportion of those infected will suffer critical illness, death, or long-term disabilities such as chronic ventilator use or end stage renal disease (ESRD) [ 32 , 33 ].…”