title: Attempts to eradicate methicillin-resistant Staphylococcus aureus colonization with the use of trimethoprim-sulfamethoxazole, rifampin, and bacitracin.
abstract: Retrospective review of 197 patients with methicillin-resistant Staphylococcus aureus (MRSA) identified 47 in whom a regimen for eradication of MRSA colonization could be evaluated. The patients were elderly (mean age, 67.7 years), with 53% transferred from another institution and 53% treated in an intensive care unit. A mean of 47.1 days of hospitalization with an average of 4.9 antibiotics preceded the first MRSA culture. The usual regimen (mean, 6.0 days) was oral trimethoprim-sulfamethoxazole, 160/800 mg twice daily, oral rifampin, 600 mg once daily, and bacitracin ointment three times a day. Eradication succeeded in 40 patients, 9 relapsed, and MRSA persisted in 7. Twenty-four of 25 nares sites were cleared but only 16 of 22 other sites. MRSA infection eventually developed in 36%. No adverse reactions to the eradication regimen were noted. Although this treatment for MRSA carriage was safe and effective, decreased efficacy outside the nares and relapse limited its value.
authors.affiliation: Medical Services, Veterans Administration Medical Center, Omaha, NE 68105.
authors.forename: J S
authors.initials: JS
authors.lastname: Roccaforte
authors.forename: M J
authors.initials: MJ
authors.lastname: Bittner
authors.forename: C A
authors.initials: CA
authors.lastname: Stumpf
authors.forename: L C
authors.initials: LC
authors.lastname: Preheim
mesh_terms: D000368:Aged; D001414:Bacitracin / Q000627:therapeutic use*; D002353:Carrier State / Q000188:drug therapy; D003428:Cross Infection / Q000517:prevention & control*; D004338:Drug Combinations / Q000627:therapeutic use; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D006745:Hospital Bed Capacity, 300 to 499; D006801:Humans; D008712:Methicillin / Q000494:pharmacology; D008875:Middle Aged; D009329:Nebraska; D010403:Penicillin Resistance; D012189:Retrospective Studies; D012293:Rifampin / Q000627:therapeutic use*; D013203:Staphylococcal Infections / Q000188:drug therapy*; D013211:Staphylococcus aureus / Q000187:drug effects* / Q000302:isolation & purification; D013420:Sulfamethoxazole / Q000627:therapeutic use*; D014295:Trimethoprim / Q000627:therapeutic use*; D015662:Trimethoprim, Sulfamethoxazole Drug Combination
chemical_list: D004338:Drug Combinations; D001414:Bacitracin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D014295:Trimethoprim; D013420:Sulfamethoxazole; D008712:Methicillin; D012293:Rifampin