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Highly Effective Regimen for Decolonization of Methicillin-Resistant Staphylococcus aureus Carriers

Published online by Cambridge University Press:  02 January 2015

M. Buehlmann ,
R. Frei ,
L. Fenner ,
M. Dangel ,
U. Fluckiger  and
A. F. Widmer
M. Buehlmann
Affiliation:
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
R. Frei
Affiliation:
Microbiology Laboratory, University Hospital Basel, Basel, Switzerland
L. Fenner
Affiliation:
Microbiology Laboratory, University Hospital Basel, Basel, Switzerland
M. Dangel
Affiliation:
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
U. Fluckiger
Affiliation:
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
A. F. Widmer*
Affiliation:
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
*
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland (awidmer@uhbs.ch)
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Abstract

Objective.

To evaluate the efficacy of a standardized regimen for decolonization of methicillin-resistant Staphylococcus aureus (MRSA) carriers and to identify factors influencing decolonization treatment failure.

Design.

Prospective cohort study from January 2002 to April 2007, with a mean follow-up period of 36 months.

Setting.

University hospital with 750 beds and 27,000 admissions/year.

Patients.

Of 94 consecutive hospitalized patients with MRSA colonization or infection, 32 were excluded because of spontaneous loss of MRSA, contraindications, death, or refusal to participate. In 62 patients, decolonization treatment was completed. At least 6 body sites were screened for MRSA (including by use of rectal swabs) before the start of treatment.

Interventions.

Standardized decolonization treatment consisted of mupirocin nasal ointment, chlorhexidine mouth rinse, and full-body wash with chlorhexidine soap for 5 days. Intestinal and urinary-tract colonization were treated with oral vancomycin and cotrimoxazole, respectively. Vaginal colonization was treated with povidone-iodine or, alternatively, with chlorhexidine ovula or octenidine solution. Other antibiotics were added to the regimen if treatment failed. Successful decolonization was considered to have been achieved if results were negative for 3 consecutive sets of cultures of more than 6 screening sites.

Results.

The mean age (± standard deviation [SD]) age of the 62 patients was 66.2 ± 19 years. The most frequent locations of MRSA colonization were the nose (42 patients [68%]), the throat (33 [53%]), perianal area (33 [53%]), rectum (36 [58%]), and inguinal area (30 [49%]). Decolonization was completed in 87% of patients after a mean (±SD) of 2.1 ± 1.8 decolonization cycles (range, 1-10 cycles). Sixty-five percent of patients ultimately required peroral antibiotic treatment (vancomycin, 52%; cotrimoxazole, 27%; rifampin and fusidic acid, 18%). Decolonization was successful in 54 (87%) of the patients in the intent-to-treat analysis and in 51 (98%) of 52 patients in the on-treatment analysis.

Conclusion.

This standardized regimen for MRSA decolonization was highly effective in patients who completed the full decolonization treatment course.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 6 , June 2008 , pp. 510 - 516
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

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