Highly effective regimen for decolonization of methicillin-resistant Staphylococcus aureus carriers.
OBJECTIVE
To evaluate the efficacy of a standardized regimen for decolonization of methicillin-resistant Staphylococcus aureus (MRSA) carriers and to identify factors influencing decolonization treatment failure.


METHODS
Prospective cohort study from January 2002 to April 2007, with a mean follow-up period of 36 months.


METHODS
University hospital with 750 beds and 27,000 admissions/year.


METHODS
Of 94 consecutive hospitalized patients with MRSA colonization or infection, 32 were excluded because of spontaneous loss of MRSA, contraindications, death, or refusal to participate. In 62 patients, decolonization treatment was completed. At least 6 body sites were screened for MRSA (including by use of rectal swabs) before the start of treatment.


METHODS
Standardized decolonization treatment consisted of mupirocin nasal ointment, chlorhexidine mouth rinse, and full-body wash with chlorhexidine soap for 5 days. Intestinal and urinary-tract colonization were treated with oral vancomycin and cotrimoxazole, respectively. Vaginal colonization was treated with povidone-iodine or, alternatively, with chlorhexidine ovula or octenidine solution. Other antibiotics were added to the regimen if treatment failed. Successful decolonization was considered to have been achieved if results were negative for 3 consecutive sets of cultures of more than 6 screening sites.


RESULTS
The mean age (+/- standard deviation [SD]) age of the 62 patients was 66.2 +/- 19 years. The most frequent locations of MRSA colonization were the nose (42 patients [68%]), the throat (33 [53%]), perianal area (33 [53%]), rectum (36 [58%]), and inguinal area (30 [49%]). Decolonization was completed in 87% of patients after a mean (+/-SD) of 2.1 +/- 1.8 decolonization cycles (range, 1-10 cycles). Sixty-five percent of patients ultimately required peroral antibiotic treatment (vancomycin, 52%; cotrimoxazole, 27%; rifampin and fusidic acid, 18%). Decolonization was successful in 54 (87%) of the patients in the intent-to-treat analysis and in 51 (98%) of 52 patients in the on-treatment analysis.


CONCLUSIONS
This standardized regimen for MRSA decolonization was highly effective in patients who completed the full decolonization treatment course.
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.
M
M
Buehlmann
R
R
Frei
L
L
Fenner
M
M
Dangel
U
U
Fluckiger
A F
AF
Widmer
D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000382:microbiology; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage / Q000627:therapeutic use; D002353:Carrier State / Q000188:drug therapy / Q000382:microbiology / Q000517:prevention & control; D002710:Chlorhexidine / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D016712:Mupirocin / Q000008:administration & dosage / Q000627:therapeutic use; D009666:Nose / Q000382:microbiology; D010614:Pharynx / Q000382:microbiology; D011206:Povidone-Iodine / Q000008:administration & dosage / Q000627:therapeutic use; D012007:Rectum / Q000382:microbiology; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000382:microbiology / Q000517:prevention & control; D013211:Staphylococcus aureus / Q000187:drug effects* / Q000302:isolation & purification; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage / Q000627:therapeutic use; D014640:Vancomycin / Q000008:administration & dosage / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D014640:Vancomycin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D011206:Povidone-Iodine; D016712:Mupirocin; D002710:Chlorhexidine