Skip to main content
Download PDF

Nasal colonization with methicillin-resistant Staphylococcus aureus: Clinical implications and treatment

Current Infectious Disease Reports volume 9, pages 201–207 (2007)Cite this article

Abstract

Methicillin-resistant Staphylococcus aureus (MRSA) has become an increasingly important pathogen during the past 30 years, and infections due to MRSA are associated with substantial morbidity and mortality. Despite intensive infection control measures, the prevalence of MRSA has increased significantly, and the organism has become endemic in many hospitals worldwide. Asymptomatic nasal carriage of MRSA has been identified as a major risk factor for subsequent S. aureus infection in multiple settings and populations. As a result, considerable interest exists in developing decolonization strategies, with the ultimate goal of reducing the incidence of MRSA infection. Approaches to decolonization have included the use of systemic and inhalation antibiotics, antiseptic washes, and topical antimicrobials.

References and Recommended Reading

  1. Chiang FY, Climo M: Staphylococcus aureus carriage and health care-acquired infection. Curr Infect Dis Rep 2002, 4:498–504.

    PubMed  Article  Google Scholar 

  2. Peacock SJ, Justice A, Griffiths D, et al.: Determinants of acquisition and carriage of Staphylococcus aureus in infancy. J Clin Microbiol 2003, 41:5718–5725.

    PubMed  Article  Google Scholar 

  3. Graham PL, Lin SX, Larson EL: A U.S. population-based survey of Staphylococcus aureus colonization. Ann Intern Med 2006, 144:318–325.

    PubMed  Google Scholar 

  4. Jernigan JA, Pullen AL, Partin C, Jarvis WR: Prevalence of and risk factors for colonization with methicillin-resistant Staphylococcus aureus in an outpatient clinic population. Infect Control Hosp Epidemiol 2003, 24:445–450.

    PubMed  Article  Google Scholar 

  5. Calfee DP, Durbin LJ, Germanson TP, et al.: Spread of methicillin-resistant Staphylococcus aureus (MRSA) among household contacts of individuals with nosocomially acquired MRSA. Infect Control Hosp Epidemiol 2003, 24:422–426.

    PubMed  Article  Google Scholar 

  6. Coello R, Glynn JR, Gaspar C, et al.: Risk factors for developing clinical infection with methicillin-resistant Staphylococcus aureus (MRSA) amongst hospital patients initially only colonized with MRSA. J Hosp Infect 1997, 37:39–46.

    PubMed  Article  CAS  Google Scholar 

  7. Sanford MD, Widmer AF, Bale MJ, et al.: Efficient detection and long-term persistence of the carriage of methicillin-resistant Staphylococcus aureus. Clin Infect Dis 1994, 19:1123–1128.

    PubMed  CAS  Google Scholar 

  8. von Eiff C, Becker K, Machka K, et al.: Nasal carriage as a source of Staphylococcus aureus bacteremia. N Engl J Med 2001, 334:11–16.

    Article  Google Scholar 

  9. Pujol M, Pena C, Pallares R, et al.: Nosocomial Staphylococcus aureus bacteremia among nasal carriers of methicillin-resistant and methicillin-susceptible strains. Am J Med 1996, 100:509–516.

    PubMed  Article  CAS  Google Scholar 

  10. Huang SS, Platt R: Risk of methicillin-resistant Staphylococcus aureus infection after previous infection or colonization. Clin Infect Dis 2003, 36:281–285.

    PubMed  Article  Google Scholar 

  11. Blot SI, Vandewoude KH, Hoste EA, et al.: Outcome and attributable mortality in critically ill patients with bacteremia involving methicillin-susceptible and methicillin-resistant Staphylococcus aureus. Arch Intern Med 2002, 162:2229–2235.

    PubMed  Article  Google Scholar 

  12. Das I, O’connell N, Lambert P: Epidemiology, clinical and laboratory characteristics of Staphylococcus aureus bacteraemia in a university hospital in UK. J Hosp Infect 2007, 65:117–123.

    PubMed  Article  CAS  Google Scholar 

  13. Scanvic A, Denic L, Gaillon S, et al.: Duration of colonization by methicillin-resistant Staphylococcus aureus after hospital discharge and risk factors for prolonged carriage. Clin Infect Dis 2001, 32:1393–1398.

    PubMed  Article  CAS  Google Scholar 

  14. MacKinnon MM, Allen KD: Long-term MRSA carriage in hospital patients. J Hosp Infect 2000, 46:216–221.

    PubMed  CAS  Google Scholar 

  15. Ridenour GA, Wong ES, Call MA, et al.: Duration of colonization with methicillin-resistant Staphylococcus aureus among patients in the intensive care unit: implications for intervention. Infect Control Hosp Epidemiol 2006, 27:271–278.

    PubMed  Article  Google Scholar 

  16. Boyce JM: MRSA patients: proven methods to treat colonization and infection. J Hosp Infect 2001, 48(Suppl A):S9–S14.

    PubMed  Article  Google Scholar 

  17. Muder RR, Boldin M, Brennen C, et al.: A controlled trial of rifampicin, minocycline, and rifampicin plus minocycline for eradication of mehticillin-resistant Staphylococcus aureus in long-term care patients. J Antimicrob Chemother 1994, 34:189–190.

    PubMed  Article  CAS  Google Scholar 

  18. Peterson LR, Quick JN, Jensen B, et al.: Emergence of ciprofloxacin resistance in nosocomial methicillin-resistant Staphylococcus aureus isolates. Arch Intern Med 1990, 150:2151–2155.

    PubMed  Article  CAS  Google Scholar 

  19. Walsh TJ, Standiford HC, Reboli AC, et al.: Randomized double-blinded trial of rifampin with either novobiocin or trimethoprim-sulfamethoxazole against methicillin-resistant Staphylococcus aureus colonization: prevention of antimicrobial resistance and effect of host factors on outcome. Antimicrob Agents Cemthother 1993, 37:1334–1342.

    CAS  Google Scholar 

  20. Loeb M, Main C, Walker-Dilks C, Eady A: Antimicrobial drugs for treating methicillin-resistant Staphylococcus aureus colonization. Cochrane Database Syst Rev 2003, (4):CD003340.

  21. Loveday HP, Pellowe CM, Jones SR, et al.: A systematic review of the evidence for interventions for the prevention and control of methicillin-resistant Staphylococcus aureus (1996–2004): report to the Joint MRSA Working Party (Subgroup A). J Hosp Infect 2006, 635:S45–S70.

    Article  Google Scholar 

  22. Weathers L, Riggs D, Santeiro M, et al.: Aerosolized vancomycin for treatment of airway colonization by methicillin-resistant Staphylococcus aureus. Pediatr Infect Dis J 1990, 9:220–221.

    PubMed  Article  CAS  Google Scholar 

  23. Roccaforte JS, Bittner MJ, Stumpf CA, et al.: Attempts to eradicate methicillin-resistant Staphylococcus aureus colonization with use of trimethoprim-sulfamethoxazole, rifampin, and bacitracin. Am J Infect Control 1988, 16:141–146.

    PubMed  Article  CAS  Google Scholar 

  24. Gemmell CG, Edwards DI, Fraise AP, et al.: Guidelines for the prophylaxis and treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections in the UK. J Antimicrob Chemother 2006, 57:589–608.

    PubMed  Article  CAS  Google Scholar 

  25. Soto NE, Vaghjimal A, Stahl-Avicolli A, et al.: Bacitracin versus mupirocin for Staphylococcal aureus nasal colonization. Infect Control Hosp Epidemiol 1999, 20:351–353.

    PubMed  Article  CAS  Google Scholar 

  26. Fung S, O’Grady S, Kennedy C, et al.: The utility of polysporin ointment in eradication of methicillin-resistant Staphylococcus aureus colonization: a pilot study. Infect Control Hosp Epidemiol 2000, 21:653–655.

    PubMed  Article  CAS  Google Scholar 

  27. Jones RN, Li Q, Kohut B, et al.: Contemporary antimicrobial activity of triple antibiotic ointment: a multiphased study of recent clinical isolates in the United States and Australia. Diagn Microbiol Infect Dis 2006, 54:63–71.

    PubMed  Article  CAS  Google Scholar 

  28. Sesso R, Parisio K, Dalboni A, et al.: Effect of sodium fusidate and ofloxacin on Staphylococcus aureus colonization and infection in patients on continuous ambulatory peritoneal dialysis. Clin Nephrol 1994, 41:370–376.

    PubMed  CAS  Google Scholar 

  29. Ericson C, Larsson S: Methicillin-resistant staphylococci as an epidemiological indication for gentamicin therapy. Acta Pathol Microbiol Scan [B] Microbiol Immunol 1973, 241(Suppl):65–68.

    Google Scholar 

  30. Parras F, Guerrero MC, Bouza E, et al.: Comparative study of mupirocin and oral co-trimoxazole plus topical fusidic acid in eradication of nasal carriage of methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother 1995, 39:175–179.

    PubMed  CAS  Google Scholar 

  31. Masano H, Fukuchi K, Wakuta R, et al.: Efficacy of intranasal application of povidone-iodine cream in eradicating nasal methicillin-resistant Staphylococcus aureus in neonatal intensive care unit (NICU) staff. Postgrad Med J 1993, 69(Suppl 3):S122–S125.

    PubMed  Google Scholar 

  32. Casewell MW, Hill RL: Elimination of nasal carriage of Staphylococcus aureus with mupirocin (’pseudomonic acid’)—a controlled trial. J Antimicrob Chemother 1986, 7:365–372.

    Article  Google Scholar 

  33. Redhead RJ, Lamb YJ, Rowsell RB: The efficacy of calcium mupirocin in the eradication of nasal Staphylococcus aureus carriage. Br J Clin Pharmacol 1991, 45:252–254.

    CAS  Google Scholar 

  34. Deshpande LM, Fix AM, Pfaller MA, et al.: SENTRY Antimicrobial Surveillance Program Participants Group. Emerging elevated mupirocin resistance rates among staphylococcal isolates in the SENTRY Antimicrobial Surveillance Program (2000): correlations of results from disk diffusion, Etest and reference dilution methods. Diagn Microbiol Infect Dis 2002, 42:283–290.

    PubMed  Article  CAS  Google Scholar 

  35. Upton A, Lang S, Heffernan H: Mupirocin and Staphylococcus aureus: a recent paradigm of emerging antibiotic resistance. J Antimicrob Chemother 2003, 51:613–617.

    PubMed  Article  CAS  Google Scholar 

  36. Fawley WN, Parnell P, Hall J, Wilcox MH: Surveillance for mupirocin resistance following introduction of routine peri-operative prophylaxis with nasal mupirocin. J Hosp Infect 2006, 62:327–332.

    PubMed  Article  CAS  Google Scholar 

  37. Centers for Disease Control and Prevention: Recommendations for preventing the spread of vancomycin resistance. Recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC). MMWR Recommend Rep 1995, 44(RR-12):1–13.

    Google Scholar 

  38. Caelli M, Porteous J, Carson CF, et al.: Tea tree oil as an alternative topical decolonization agent for methicillin-resistant Staphylococcus aureus. J Hosp Infect 2000, 46:236–237.

    PubMed  CAS  Google Scholar 

  39. Dryden MS, Dailly S, Crouch M: A randomized, controlled trial of tea tree topical preparations versus a standard topical regimen for the clearance of MRSA colonization. J Hosp Infect 2004, 56:281–286.

    Article  Google Scholar 

  40. Quickel KE Jr, Selden R, Caldwell JR, et al.: Efficacy and safety of topical lysostaphin treatment of persistent nasal carriage of Staphylococcus aureus. Appl Microbiol 1971, 22:446–450.

    PubMed  Google Scholar 

  41. Watanakunakorn C, Axelson C, Bota B, et al.: Mupirocin ointment with and without chlorhexidine baths in the eradication of Staphylococcus aureus nasal carriage in nursing home residents. Am J Infect Control 1995, 23:306–309.

    PubMed  Article  CAS  Google Scholar 

  42. Harbarth S, Liassine N, Dharan S, et al.: Risk factors for persistent carriage of methicillin-resistant Staphylococcus aureus. Clin Infect Dis 2000, 31:1380–1385.

    PubMed  Article  CAS  Google Scholar 

  43. Simor AE, Philips E, McGeer A, et al.: Randomized controlled trial of chlorhexidine gluconate for washing, intranasal mupirocin, and rifampin and doxycycline versus no treatment for the eradication of methicillin-resistant Staphylococcus aureus colonization. Clin Infect Dis 2007, 44:178–185.

    PubMed  Article  CAS  Google Scholar 

  44. Parras F, Guerrero MC, Bouza E, et al.: Comparative study of mupirocin and oral co-trimoxazole plus topical fusidic acid in eradication of nasal carriage of methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother 1995, 39:175–179.

    PubMed  CAS  Google Scholar 

  45. Wenisch C, Laferl H, Szell M, et al.: A holistic approach to MRSA eradication in critically ill patients with MRSA pneumonia. Infection 2006, 34:148–154.

    PubMed  Article  CAS  Google Scholar 

  46. Tacconelli E, Carmeli Y, Aizer A, et al.: Mupirocin prophylaxis to prevent Staphylococcus aureus infection in patients undergoing dialysis: a meta-analysis. Clin Infect Dis 2003, 37:1629–1638.

    PubMed  Article  CAS  Google Scholar 

  47. Perl TM, Cullen JJ, Wenzel RP, et al.: Intranasal mupirocin to prevent postoperative Staphylococcus aureus infections. N Engl J Med 2002, 346:1871–1877.

    PubMed  Article  CAS  Google Scholar 

  48. Dupeyron C, Campillo B, Richardet JP, et al.: Long-term efficacy of mupirocin in the prevention of infections with methicillin-resistant Staphylococcus aureus in a gastroenterology unit. J Hosp Infect 2006, 63:385–392.

    PubMed  Article  CAS  Google Scholar 

  49. Shitrit P, Gottesman BS, Katzir M, et al.: Active surveillance for methicillin-resistant Staphylococcus aureus (MRSA) decreases the incidence of MRSA bacteremia. Infect Control and Hosp Epidemiol 2006, 27:1004–1008.

    Article  Google Scholar 

  50. Muller A, Talon D, Potier AP, et al.: Use of intranasal mupirocin to prevent methicillin-resistant Staphylococcus aureus infection in intensive care units. Crit Care 2005, 9:R246–R250.

    PubMed  Article  Google Scholar 

  51. Girou E, Pujade G, Legrand P, et al.: Selective screening of carriers for control of methicillin-resistant Staphylococcus aureus (MRSA) in high-risk hospital areas with high level of endemic MRSA. Clin Infect Dis 1998, 27:543–550.

    PubMed  CAS  Google Scholar 

  52. Khoury J, Jones M, Grim A, et al.: Eradication of methicillin-resistant Staphylococcus aureus from a neonatal intensive care unit by active surveillance and aggressive infection control measures. Infect Control Hosp Epidemiol 2005, 26:616–621.

    PubMed  Article  Google Scholar 

  53. Sandri AM, Dalarosa MG, Ruschel de Alcantara L, et al.: Reduction in incidence of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection in an intensive care unit: role of treatment with mupirocin ointment and chlorhexidine baths for nasal carriers of MRSA. Infect Control Hosp Epidemiol 2006, 27:185–187.

    PubMed  Article  Google Scholar 

Download references

Author information

Affiliations

  1. McGuire Veteran Affairs Medical Center, 1201 Broad Rock Boulevard, Section 111-C, Richmond, VA, 23236, USA

    Michael Climo MD

Authors
  1. David Friedel MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael Climo MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael Climo MD.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Friedel, D., Climo, M. Nasal colonization with methicillin-resistant Staphylococcus aureus: Clinical implications and treatment. Curr Infect Dis Rep 9, 201–207 (2007). https://doi.org/10.1007/s11908-007-0032-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11908-007-0032-1

Keywords

  • Mupirocin
  • Fusidic Acid
  • Infect Control Hosp
  • Nasal Colonization
  • Hosp Infect