title: Eradication of carriage with methicillin-resistant Staphylococcus aureus: determinants of treatment failure.
abstract: BACKGROUND
  Using data from an observational study in which the effectiveness of a guideline for eradication of methicillin-resistant Staphylococcus aureus (MRSA) carriage was evaluated, we identified variables that were associated with treatment failure.
  
  
  METHODS
  A multivariate logistic regression model was performed with subgroup analyses for uncomplicated and complicated MRSA carriage (the latter including MRSA infection, skin lesions, foreign-body material, mupirocin resistance and/or exclusive extranasal carriage) and for those treated according to the guideline (i.e. mupirocin nasal ointment and chlorhexidine soap solution for uncomplicated carriage, in combination with two oral antibiotics for complicated carriage).
  
  
  RESULTS
  Six hundred and thirteen MRSA carriers were included, of whom 333 (54%) had complicated carriage; 327 of 530 patients (62%) with known complexity of carriage were treated according to the guideline with an absolute increase in treatment success of 20% (95% confidence interval 12%-28%). Among those with uncomplicated carriage, guideline adherence [adjusted odds ratio (OR(a)) 7.4 (1.7-31.7)], chronic pulmonary disease [OR(a) 44 (2.9-668)], throat carriage [OR(a) 2.9 (1.4-6.1)], perineal carriage [OR(a) 2.2 (1.1-4.4)] and carriage among household contacts [OR(a) 5.6 (1.2-26)] were associated with treatment failure. Among those with complicated carriage, guideline adherence was associated with treatment success [OR(a) 0.2 (0.1-0.3)], whereas throat carriage [OR(a) 4.4 (2.3-8.3)] and dependence in activities of daily living [OR(a) 3.6 (1.4-8.9)] were associated with failure.
  
  
  CONCLUSIONS
  Guideline adherence, especially among those with complicated MRSA carriage, was associated with treatment success. Adding patients with extranasal carriage or dependence in daily self-care activities to the definition of complicated carriage, and treating them likewise, may further increase 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 / Q000008:administration & dosage / Q000627:therapeutic use*; D058345:Asymptomatic Infections; D002353:Carrier State / Q000188:drug therapy* / Q000382:microbiology; D002710:Chlorhexidine / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D016015:Logistic Models; D008297:Male; D016106:Methicillin Resistance; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects*; D008875:Middle Aged; D016712:Mupirocin / Q000008:administration & dosage / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology; D017211:Treatment Failure
chemical_list: D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D016712:Mupirocin; D002710:Chlorhexidine