title: Eradication of carriage with methicillin-resistant Staphylococcus aureus: effectiveness of a national guideline.
abstract: BACKGROUND
  We evaluated the effectiveness of eradication of methicillin-resistant Staphylococcus aureus (MRSA) carriage in the Netherlands after the introduction of a guideline in 2006. The guideline distinguishes complicated (defined as the presence of MRSA infection, skin lesions, foreign-body material, mupirocin resistance and/or exclusive extranasal carriage) and uncomplicated carriage (not meeting criteria for complicated carriage). Mupirocin nasal ointment and chlorhexidine soap solution are recommended for uncomplicated carriers and the same treatment in combination with two oral antibiotics for complicated carriage.
  
  
  METHODS
  A prospective cohort study was performed in 18 Dutch centres from 1 October 2006 until 1 October 2008.
  
  
  RESULTS
  Six hundred and thirteen MRSA carriers underwent one or more decolonization treatments during the study period, mostly after hospital discharge. Decolonization was achieved in 367 (60%) patients with one eradication attempt and ultimately 493 (80%) patients were decolonized, with a median time until decolonization of 10 days (interquartile range 7-43 days). Three hundred and twenty-seven (62%) carriers were treated according to the guideline, which was associated with an absolute increase in treatment success of 20% [from 45% (91/203) to 65% (214/327)].
  
  
  CONCLUSIONS
  Sixty percent of MRSA carriers were successfully decolonized after the first eradication attempt and 62% were treated according to the guideline, which was associated with an increased treatment success.
authors: Department of Medical Microbiology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. h.ammerlaan@umcutrecht.nl
authors: Heidi S M
authors: HS
authors: Ammerlaan
authors: Jan A J W
authors: JA
authors: Kluytmans
authors: Hanneke
authors: H
authors: Berkhout
authors: Anton
authors: A
authors: Buiting
authors: Els I G B
authors: EI
authors: de Brauwer
authors: Peterhans J
authors: PJ
authors: van den Broek
authors: Paula
authors: P
authors: van Gelderen
authors: Sander A C A P
authors: SA
authors: Leenders
authors: Alewijn
authors: A
authors: Ott
authors: Clemens
authors: C
authors: Richter
authors: Lodewijk
authors: L
authors: Spanjaard
authors: Ingrid J B
authors: IJ
authors: Spijkerman
authors: Frank H
authors: FH
authors: van Tiel
authors: G Paul
authors: GP
authors: Voorn
authors: Mireille W H
authors: MW
authors: Wulf
authors: Jan
authors: J
authors: van Zeijl
authors: Annet
authors: A
authors: Troelstra
authors: Marc J M
authors: MJ
authors: Bonten
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D058345:Asymptomatic Infections; D002353:Carrier State / Q000188:drug therapy* / Q000382:microbiology; D002710:Chlorhexidine / Q000627:therapeutic use; D015331:Cohort Studies; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects*; D008875:Middle Aged; D016712:Mupirocin / Q000008:administration & dosage / Q000627:therapeutic use; D009426:Netherlands; D017410:Practice Guidelines as Topic; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D016712:Mupirocin; D002710:Chlorhexidine