title: Follow-up cultures for MRSA after eradication therapy: are three culture-sets enough?
abstract: OBJECTIVE
  We compared the standard procedure of three MRSA follow-up culture sets to six to determine the number of recurrences detected between the third and sixth follow-up culture-set, and studied possible risk factors for MRSA recurrence.
  
  
  METHODS
  A retrospective carrier cohort (2005-2010) was studied. Data was collected on MRSA culture-sets, follow-up, risk factors and outcome (recurrences during follow-up). We compared outcome between three and six follow-up MRSA culture sets, between HCWs and patients groups for complicated or uncomplicated carriers, and between nose-throat carriers and other carriers.
  
  
  RESULTS
  Of 406 MRSA carriers, 179 had received eradication therapy and had a negative first follow-up MRSA culture-set. Between the third and sixth follow-up culture-set 54% (35/65) of total recurrences occurred. Over 88% of all recurrences were detected within two months. Combined nose and throat carriage OR 25.5 (1.6-419.1)) and intravascular lines (OR 13.6 (1.2-156.2)) were risk factors for early recurrence.
  
  
  CONCLUSIONS
  We recommend five culture-sets till one year after successful eradication therapy with a distinction between those at risk for early recurrence and HCWs who require frequent culturing in the beginning and those not at risk for early recurrence. This recommendation is a balance between the need for swift detection of MRSA recurrence and the patients' burden.
authors.affiliation: Erasmus MC, University Medical Center Rotterdam, Department of Medical Microbiology and Infectious Diseases, Rotterdam, The Netherlands. Electronic address: w.lekkerkerk@erasmusmc.nl.
authors.forename: Wouter S N
authors.initials: WS
authors.lastname: Lekkerkerk
authors.affiliation: Erasmus MC, University Medical Center Rotterdam, Department of Medical Microbiology and Infectious Diseases, Rotterdam, The Netherlands.
authors.forename: Marissa
authors.initials: M
authors.lastname: Uljee
authors.affiliation: Erasmus MC, University Medical Center Rotterdam, Department of Medical Microbiology and Infectious Diseases, Rotterdam, The Netherlands.
authors.forename: Ante
authors.initials: A
authors.lastname: Prkić
authors.affiliation: Erasmus MC, University Medical Center Rotterdam, Department of Medical Microbiology and Infectious Diseases, Rotterdam, The Netherlands.
authors.forename: Britta D P J
authors.initials: BD
authors.lastname: Maas
authors.affiliation: Erasmus MC, University Medical Center Rotterdam, Department of Medical Microbiology and Infectious Diseases, Rotterdam, The Netherlands.
authors.forename: Juliëtte A
authors.initials: JA
authors.lastname: Severin
authors.affiliation: Erasmus MC, University Medical Center Rotterdam, Department of Medical Microbiology and Infectious Diseases, Rotterdam, The Netherlands.
authors.forename: Margreet C
authors.initials: MC
authors.lastname: Vos
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002353:Carrier State / Q000188:drug therapy* / Q000382:microbiology*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects* / Q000254:growth & development / Q000302:isolation & purification*; D008875:Middle Aged; D009666:Nose / Q000382:microbiology; D010614:Pharynx / Q000382:microbiology; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents
keywords: Disease eradication; Follow-up studies; MRSA; Recurrence; Risk factors