Eradication of carriage with methicillin-resistant Staphylococcus aureus: effectiveness of a national guideline

• Published in: Journal of antimicrobial chemotherapy Vol. 66; no. 10; pp. 2409 - 2417
• Main Authors: Ammerlaan, Heidi S. M., Kluytmans, Jan A. J. W., Berkhout, Hanneke, Buiting, Anton, de Brauwer, Els I. G. B., van den Broek, Peterhans J., van Gelderen, Paula, Leenders, Sander (A.) C. A. P., Ott, Alewijn, Richter, Clemens, Spanjaard, Lodewijk, Spijkerman, Ingrid J. B., van Tiel, Frank H., Voorn, G. Paul, Wulf, Mireille W. H., van Zeijl, Jan, Troelstra, Annet, Bonten, Marc J. M.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.10.2011; Oxford Publishing Limited (England)
• Subjects: Adult; Aged; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - therapeutic use; Anti-Infective Agents, Local - therapeutic use; Antibiotics; Antibiotics. Antiinfectious agents. Antiparasitic agents; Asymptomatic Infections; Bacterial diseases; Biological and medical sciences; Carrier State - drug therapy; Carrier State - microbiology; Chlorhexidine - therapeutic use; Cohort Studies; Cross Infection - drug therapy; Cross Infection - microbiology; Drug resistance; Female; Human bacterial diseases; Humans; Infectious diseases; Male; Medical sciences; Medical treatment; Methicillin-Resistant Staphylococcus aureus - drug effects; Middle Aged; Mupirocin - administration & dosage; Mupirocin - therapeutic use; Netherlands; Pharmacology. Drug treatments; Practice Guidelines as Topic; Staphylococcal Infections - drug therapy; Staphylococcal Infections - microbiology; Staphylococcal infections, streptococcal infections, pneumococcal infections; Staphylococcus aureus; Staphylococcus infections; Treatment Outcome; Netherlands; Europe; treatment; decolonization; colonization; Dutch guideline; success; Eradication; Recommendation; Infection; Treatment; Efficiency; Bacteriosis; Bacteria; Micrococcales; Micrococcaceae; Staphylococcal infection; Colonization; Staphylococcus aureus
• ISSN: 0305-7453; 1460-2091
• DOI: 10.1093/jac/dkr243

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.