title: The search and destroy strategy prevents spread and long-term carriage of methicillin-resistant Staphylococcus aureus: results from the follow-up screening of a large ST22 (E-MRSA 15) outbreak in Denmark.
abstract: In the aftermath of a methicillin-resistant Staphylococcus aureus (MRSA) ST22 hospital outbreak, we investigated the prevalence of long-term carriage, the efficacy of MRSA decolonization treatment (DT) and the spread of MRSA to households of patients and healthcare workers (HCWs). Furthermore, we evaluated the efficacy of repeated DT in long-term MRSA carriers. Of 250 index persons (58 HCWs and 192 patients), 102 persons (19 HCWs and 83 patients) and 67 household members agreed to participate. Samples from all 169 persons were taken from the nose, throat, wounds and devices/catheters, and urine samples were additionally taken from index persons. Samples from companion animals (n = 35) were taken from the nostrils and anus. Environmental sites (n = 490) screened were telephone, television remote control, toilet flush handle, favourite chair and skirting board beside the bed. Sixteen (19%) patients and two household members, but no HCWs, were ST22-positive. The throat was the most frequent site of colonization. In a multivariate analysis, chronic disease (p <0.001) and pharyngeal carriage (p <0.001) were associated with long-term MRSA carriage. MRSA was found in the environments of four long-term carriers. All animals tested were negative. MRSA-positive households were decolonized using nasal mupirocin TID and daily chlorhexidine body and hair wash for 5 days. Pharyngeal MRSA carriers also received fucidic acid (500 mg TID) combined with rifampicin (600 mg BID) or clindamycin (600 mg BID) for 7 days. The home environment was cleaned on days 2 and 5. At the end of follow-up, ten of 16 long-term carriers and the two household contacts were MRSA-negative. In conclusion, decolonization of MRSA carriers is possible, but should include treatment of household members and the environment.
authors.affiliation: National Center for Antimicrobials and Infection Control, Statens Serum Institut, Copenhagen, Denmark. sbc@ssi.dk
authors.forename: S
authors.initials: S
authors.lastname: Böcher
authors.forename: R L
authors.initials: RL
authors.lastname: Skov
authors.forename: M A
authors.initials: MA
authors.lastname: Knudsen
authors.forename: L
authors.initials: L
authors.lastname: Guardabassi
authors.forename: K
authors.initials: K
authors.lastname: Mølbak
authors.forename: P
authors.initials: P
authors.lastname: Schouenborg
authors.forename: M
authors.initials: M
authors.lastname: Sørum
authors.forename: H
authors.initials: H
authors.lastname: Westh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002353:Carrier State / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D002415:Cats; D002648:Child; D002675:Child, Preschool; D003718:Denmark / Q000453:epidemiology; D004196:Disease Outbreaks; D004285:Dogs; D004783:Environmental Microbiology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D009666:Nose / Q000382:microbiology; D010614:Pharynx / Q000382:microbiology; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D014556:Urine / Q000382:microbiology; D014947:Wounds and Injuries / Q000382:microbiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents