Care for MRSA carriers in the outpatient sector: a survey among MRSA carriers and physicians in two regions in Germany.
BACKGROUND
Little is known about the management of methicillin-resistant Staphylococcus aureus (MRSA) carriers in the German outpatient sector and about the impact of MRSA on their daily life. Reimbursement for MRSA related costs in the German outpatient sector is available since 2012, but its impact has not been studied yet. The aim of the study was to analyze the outpatient management of MRSA carriers from both, physicians' and MRSA carriers' perspective.


METHODS
Paper-based questionnaires were mailed to physicians providing outpatient care and to MRSA carriers in 2013. MRSA carriers were recruited among patients tested positive for MRSA during a hospital stay in 2012. General practitioners, specialists for internal medicine, urologists, and dermatologists working in the outpatient catchment areas of the hospitals were contacted.


RESULTS
Out of 910 MRSA carriers 16.5 % completed the questionnaires; among 851 physicians 9.5 % participated. 27.3 % of the responding MRSA carriers stated that no healthcare professional had ever talked to them about MRSA. 17.4 % reported self-stigmatization in terms of restricting social contacts; 47.3 % remembered decolonization and 33.3 % reported that their MRSA status was checked after discharge. Physicians displayed heterogeneous attitude and activity towards MRSA (number of applied decolonization and MRSA screenings). A minority (15.2 %) were satisfied with the reimbursement of costs, 35.9 % reported full agreement with the general recommendations for the handling of MRSA carriers.


CONCLUSIONS
MRSA carriers appear not well informed; (self-) stigmatization is occurring and should be tackled. Greater awareness of MRSA as a problem in the outpatient sector could lead to a better handling of MRSA carriers.
Department Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstr. 7, 38124, Braunschweig, Germany.
Heike
H
Raupach-Rosin
Department Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstr. 7, 38124, Braunschweig, Germany.|PhD Programme "Epidemiology", Braunschweig-Hannover, Germany.
Nicole
N
Rübsamen
Städtisches Klinikum Braunschweig, Institut für Mikrobiologie, Immunologie und Krankenhaushygiene, Braunschweig, Germany.
Sebastian
S
Szkopek
Helios Klinikum Wuppertal, Abteilung für Onkologie und Palliativmedizin, Heusnerstraße 40, 42283, Wuppertal, Germany.
Oliver
O
Schmalz
Department Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstr. 7, 38124, Braunschweig, Germany.|PhD Programme "Epidemiology", Braunschweig-Hannover, Germany.|German Centre for Infection Research, Hannover-Braunschweig, Germany.
André
A
Karch
Department Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstr. 7, 38124, Braunschweig, Germany. rafael.mikolajczyk@helmholtz-hzi.de.|German Centre for Infection Research, Hannover-Braunschweig, Germany. rafael.mikolajczyk@helmholtz-hzi.de.|Hannover Medical School, Hannover, Germany. rafael.mikolajczyk@helmholtz-hzi.de.
Rafael
R
Mikolajczyk
Department Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstr. 7, 38124, Braunschweig, Germany.
Stefanie
S
Castell
D002353:Carrier State; D005260:Female; D005858:Germany; D007722:Health Knowledge, Attitudes, Practice; D006761:Hospitals; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D016017:Odds Ratio; D010045:Outpatients; D010820:Physicians / Q000523:psychology*; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology; D011795:Surveys and Questionnaires
Decolonization; MRSA; Outpatient sector; Stigmatization