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Eradicating MRSA carriage: the impact of throat carriage and Panton-Valentine leukocidin genes on success rates

  • Kristian BaggeEmail author
  • Thomas Benfield
  • Henrik Westh
  • Mette D. Bartels
Original Article

Abstract

In Denmark, eradication treatment is recommended for methicillin-resistant Staphylococcus aureus (MRSA) carriers. Here, we analyze factors associated with eradication outcome. MRSA carriers referred to the MRSA Knowledge Center at Hvidovre Hospital in 2013 were included. Carriers were sampled from nose, throat, and perineum. Eradication regimen was 5 days of mupirocin nasal ointment and chlorhexidine whole-body wash. Oral antibiotics were sometimes added. Factors associated with eradication after the first eradication attempt were analyzed by logistic regression and expressed as odds ratio (OR) with 95% confidence interval (95% CI). Of 164 individuals, 143 completed 1- and 6-month follow-up after 1st treatment. Eradication was achieved in 63 (38.4%) patients after one treatment and 101 (61.6%) individuals became MRSA free after up to 4 eradication treatments. Throat carriage was associated with a higher failure rate (OR 0.29 (0.10–0.80)), while the presence of Panton-Valentine leukocidin (PVL) genes (37%) was associated with higher success rate (OR 3.52 (1.44–8.57)). Other factors analyzed were not significantly associated with eradication outcome. None of the 26 patients lost to follow-up developed later MRSA infections. This study estimates the efficacy of treatment of MRSA carriage with an eradication rate of 38.4% after the first treatment and a total eradication rate of 61.6% after several treatments. Throat carriers had a lower eradication success rate. Adding oral antibiotics to the first treatment did not increase success. The finding of a significant higher success rate when having a PVL-positive clone should be further investigated.

Keywords

Methicillin-resistant Staphylococcus aureus Infection control MRSA eradication MRSA decolonization Staphylococcal skin infections/prevention and control 

Notes

Compliance with ethical standards

This study was carried out in concordance with recommendations by The Danish National Committee on Health Research Ethics. All data were anonymized on data collection and no identifying information of any individual is included in this article.

Conflict of interest

The authors declare that they have no conflicts of interest

References

  1. 1.
    Kluytmans J, van Belkum A, Verbrugh H (1997) Nasal carriage of Staphylococcus aureus: epidemiology, underlying mechanisms, and associated risks. Clin Microbiol Rev 10:505–520 http://www.ncbi.nlm.nih.gov/pubmed/9227864 CrossRefGoogle Scholar
  2. 2.
    von Eiff C, Becker K, Machka K, Stammer H, Peters G (2001) Nasal carriage as a source of Staphylococcus aureus bacteremia. Study Group. N Engl J Med 344:11–16. http://www.ncbi.nlm.nih.gov/pubmed/11136954.  https://doi.org/10.1056/NEJM200101043440102 CrossRefGoogle Scholar
  3. 3.
    Wertheim HFL, Melles DC, Vos MC, Van Leeuwen W, Van Belkum A, Verbrugh HA et al (2005) The role of nasal carriage in Staphylococcus aureus infections. Lancet Infect Dis 5:751–762. http://linkinghub.elsevier.com/retrieve/pii/S1473309905702954.  https://doi.org/10.1016/S1473-3099(05)70295-4 CrossRefGoogle Scholar
  4. 4.
    Danish Health Authority. Guidance on Preventing the Spread of MRSA. 2016 [cited 2018 19]; https://www.sst.dk/da/sygdom-og-behandling/smitsomme-sygdomme/mrsa/~/media/F3F52EC1C6A94C6080F50F435DA02E59.ashx
  5. 5.
  6. 6.
  7. 7.
  8. 8.
    Ammerlaan HSM, Kluytmans JAJW, Wertheim HFL, Nouwen JL, Bonten MJM (2009) Eradication of methicillin-resistant Staphylococcus aureus carriage: a systematic review. Clin Infect Dis 48:922–930. https://academic.oup.com/cid/article-lookup/doi/10.1086/597291.  https://doi.org/10.1086/597291 CrossRefGoogle Scholar
  9. 9.
    Ammerlaan HSM, Kluytmans JAJW, Berkhout H, Buiting A, de Brauwer EIGB, van den Broek PJ et al (2011) Eradication of carriage with methicillin-resistant Staphylococcus aureus: effectiveness of a national guideline. J Antimicrob Chemother 66:2409–2417. https://academic.oup.com/jac/article/66/10/2409/730258.  https://doi.org/10.1093/jac/dkr243 CrossRefGoogle Scholar
  10. 10.
    Ammerlaan HSM, Kluytmans JAJW, Berkhout H, Buiting A, De brauwer EIGB, Van den broek PJ et al (2011) Eradication of carriage with methicillin-resistant Staphylococcus aureus: Determinants of treatment failure. J Antimicrob Chemother 66:2418–2424. https://academic.oup.com/jac/article/66/10/2418/730393.  https://doi.org/10.1093/jac/dkr250 CrossRefGoogle Scholar
  11. 11.
    Gilpin DF, Small S, Bakkshi S, Kearney MP, Cardwell C, Tunney MM (2010) Efficacy of a standard meticillin-resistant Staphylococcus aureus decolonisation protocol in routine clinical practice. J Hosp Infect 75:93–98. http://linkinghub.elsevier.com/retrieve/pii/S0195670109005301.  https://doi.org/10.1016/j.jhin.2009.11.025 CrossRefGoogle Scholar
  12. 12.
    Lindgren AK, Nilsson AC, Åkesson P, Gustafsson E, Melander E (2018) Eradication of methicillin-resistant Staphylococcus aureus (MRSA) throat carriage: a randomised trial comparing topical treatment with rifampicin-based systemic therapy. Int J Antimicrob Agents 51:642–645.https://linkinghub.elsevier.com/retrieve/pii/S0924857917303138.  https://doi.org/10.1016/j.ijantimicag.2017.08.021 CrossRefGoogle Scholar
  13. 13.
    Jörgensen J, Månsson F, Janson H, Petersson AC, Nilsson AC (2018) The majority of MRSA colonized children not given eradication treatment are still colonized one year later. Systemic antibiotics improve the eradication rate. Infect Dis (Auckl) 50:1–10. https://www.tandfonline.com/doi/full/10.1080/23744235.2018.1459828.  https://doi.org/10.1080/23744235.2018.1459828 Google Scholar
  14. 14.
    Bartels MD, Larner-Svensson H, Meiniche H, Kristoffersen K, Schønning K, Nielsen JB et al (2015) Monitoring meticillin resistant Staphylococcus aureus and its spread in Copenhagen, Denmark, 2013, through routine whole genome sequencing. Eurosurveillance 30:20. http://www.ncbi.nlm.nih.gov/pubmed/25955776.  https://doi.org/10.2807/1560-7917.ES2015.20.17.21112 Google Scholar
  15. 15.
    Lekkerkerk WSN, Uljee M, Prkić A, Maas BDPJ, Severin JA, Vos MC (2015) Follow-up cultures for MRSA after eradication therapy: Are three culture-sets enough? J Infect 70:491–498. https://linkinghub.elsevier.com/retrieve/pii/S0163445315000249.  https://doi.org/10.1016/j.jinf.2015.01.006 CrossRefGoogle Scholar
  16. 16.
    Rigaill J, Morgene MF, Gavid M, Lelonge Y, He Z, Carricajo A, et al. Intracellular activity of antimicrobial compounds used for Staphylococcus aureus nasal decolonization. J Antimicrob Chemother 2018 16;1–5. https://academic.oup.com/jac/advance-article/doi/10.1093/jac/dky318/5075188  https://doi.org/10.1093/jac/dky318
  17. 17.
    Skyman E, Lindahl B, Bergbom I, Sjöström HT, Åhrén C (2016) Being met as marked – patients’ experiences of being infected with community-acquired methicillin-resistant Staphylococcus aureus (MRSA). Scand J Caring Sci 30:813–820. http://doi.wiley.com/10.1111/scs.12309.  https://doi.org/10.1111/scs.12309 CrossRefGoogle Scholar
  18. 18.
    Larsson AK, Gustafsson E, Nilsson AC, Odenholt I, Ringberg H, Melander E (2011) Duration of methicillin-resistant Staphylococcus aureus colonization after diagnosis: a four-year experience from southern Sweden. Scand J Infect Dis 43:456–462. http://www.tandfonline.com/doi/full/10.3109/00365548.2011.562530.  https://doi.org/10.3109/00365548.2011.562530 CrossRefGoogle Scholar
  19. 19.
    Lina G, Piemont Y, Godail-Gamot F, Bes M, Peter M-O, Gauduchon V et al (1999) Involvement of Panton-Valentine leukocidin--producing Staphylococcus aureus in primary skin infections and pneumonia. Clin Infect Dis 29:1128–1132. https://academic.oup.com/cid/article-lookup/doi/10.1086/313461.  https://doi.org/10.1086/313461 CrossRefGoogle Scholar
  20. 20.
    Alkharsah KR, Rehman S, Alkhamis F, Alnimr A, Diab A, Al-Ali AK (2018) Comparative and molecular analysis of MRSA isolates from infection sites and carrier colonization sites. Ann Clin Microbiol Antimicrob 17:7. https://ann-clinmicrob.biomedcentral.com/articles/10.1186/s12941-018-0260-2.  https://doi.org/10.1186/s12941-018-0260-2 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Clinical Microbiology, Hvidovre HospitalUniversity of CopenhagenHvidovreDenmark
  2. 2.Department of Infectious Diseases, Hvidovre HospitalUniversity of CopenhagenHvidovreDenmark
  3. 3.Faculty of Health and Medical Sciences, Institute of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark

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