Infection

, Volume 41, Issue 1, pp 33–40 | Cite as

MRSA decolonization: success rate, risk factors for failure and optimal duration of follow-up

  • P. Kohler
  • A. Bregenzer-Witteck
  • G. Rettenmund
  • S. Otterbech
  • M. Schlegel
Clinical and Epidemiological Study

Abstract

Purpose

Methicillin-resistant Staphylococcus aureus (MRSA) decolonization is a widely established, though controversial part of many MRSA controlling strategies. The aim of this study was to evaluate our decolonization success rate, identify the risk factors for decolonization failure and determine the optimal duration of follow-up in our low MRSA prevalence setting (2.6 % of isolates).

Methods

Every patient with newly detected MRSA colonization or infection between January 2007 and December 2009 was recruited to the study. The MRSA strategy of our institution (a 700 bed tertiary hospital in eastern Switzerland) consists of a 5-day regimen of nasal mupirocin ointment, chlorhexidin mouth rinse and whole body wash with didecyldimonium chloride. Systemic antibiotics are usually not added to the regimen.

Results

We determined a MRSA decolonization success rate of 65 % (33/51) after a median follow-up of 13 months [i.e. a tripling of the spontaneous clearance rate of 22 % (6/27) in the non-decolonized group]. The most important risk factor for decolonization failure was colonization of the respiratory tract [odds risk (OR) 9.1, 95 % confidence interval (CI) 1.2–66.7], as well as isolation of MRSA spa-type 002 ([R 5.8, 95 % CI 1.0–33.3). Of all the episodes of MRSA recurrence, 88 % (14/16) were detected within 270 days after decolonization.

Conclusion

High MRSA decolonization success rates can be achieved without the routine use of oral antibiotics. A time period of 1 year after decolonization seems to be a reasonable duration of follow-up in our setting. We encourage other institutions to take into account local MRSA epidemiology (e.g. predominance of certain subtypes) for the management of MRSA patients.

Keywords

Methicillin-resistant Staphylococcus aureus Decolonization Risk factor Spa-type Follow-up 

References

  1. 1.
    Huang S, Platt R. Risk of methicillin-resistant Staphylococcus aureus infection after previous infection or colonization. Clin Infect Dis. 2003;36:281–5.PubMedCrossRefGoogle Scholar
  2. 2.
    Boyce JM. MRSA patients: proven methods to treat colonization and infection. J Hosp Infect. 2001;48[Suppl A]:S9–14.PubMedCrossRefGoogle Scholar
  3. 3.
    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.Google Scholar
  4. 4.
    Lucet JC, Regnier B. Screening and decolonization: does methicillin-susceptible Staphylococcus aureus hold lessons for methicillin-resistant S. aureus? Clin Infect Dis. 2010;51(5):585–90.PubMedCrossRefGoogle Scholar
  5. 5.
    Robicsek A, Beaumont JL, Thomson RB Jr, Govindarajan G, Peterson LR. Topical therapy for methicillin-resistant Staphylococcus aureus colonization: impact on infection risk. Infect Control Hosp Epidemiol. 2009;30:623–32.PubMedCrossRefGoogle Scholar
  6. 6.
    Dow G, Field D, Mancuso M, Allard J. Decolonization of methicillin-resistant Staphylococcus aureus during routine hospital care: efficacy and long-term follow-up. Can J Infect Dis Med Microbiol. 2010;21(1):38–44.PubMedGoogle Scholar
  7. 7.
    Ammerlaan HS, Kluytmans JA, Wertheim HF, Nouwen JL, Bonten MJ. Eradication of methicillin-resistant Staphylococcus aureus carriage: a systematic review. Clin Infect Dis. 2009;48:922–30.PubMedCrossRefGoogle Scholar
  8. 8.
    Buehlmann M, Frei R, Fenner L, Dangel M, Fluckiger U, Widmer AF. Highly effective regimen for decolonization of methicillin-resistant Staphylococcus aureus carriers. Infect Control Hosp Epidemiol. 2008;29(6):510–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Harbarth S, Liassine N, Dharan S, Herrault P, Auckenthaler R, Pittet D. Risk factors for persistent carriage of methicillin-resistant Staphylococcus aureus. Clin Infect Dis. 2000;31(6):1380–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Institut für Klinische Mikrobiologie und Immunologie (IKMI) Antibiotika-Empfindlichkeit der wichtigsten Gram-positiven Bakterien und Gram-negativen Non-Enterobacteriaceae. St. Gallen. 2007. Available at: www.ikmi.ch.
  11. 11.
    Verhoef J, Beaujean D, Blok H, Baars A, Meyler A, van der Werken C, Weersink A. A Dutch approach to methicillin-resistant Staphylococcus aureus. Eur J Clin Microbiol Infect Dis. 1999;18(7):461–6.PubMedCrossRefGoogle Scholar
  12. 12.
    Witteck A, Rettenmund G, Schlegel M. MRSA admission screening in a low prevalence setting—much ado about nothing? Swiss Med Wkly. 2011;7(141):w13217.Google Scholar
  13. 13.
    Mathews AA, Thomas M, Appalaraju B, Jayalakshmi J. Evaluation and comparison of tests to detect methicillin-resistant Staphylococcus aureus. Indian J Pathol Microbiol. 2010;53(1):79–82.PubMedCrossRefGoogle Scholar
  14. 14.
    Brown DF, Edwards DI, Hawkey PM, et al. Guidelines for the laboratory diagnosis and susceptibility testing of methicillin-resistant Staphylococcus aureus (MRSA). J Antimicrob Chemother. 2005;56(6):1000–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Fleisch F, Oechslin EC, Gujer AR, Ritzler E, Imhof A, Ruef C, Reinhart WH. Transregional spread of a single clone of methicillin-resistant Staphylococcus aureus between groups of drug users in Switzerland. Infection. 2005;33(4):273–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Fenner L, Widmer AF, Dangel M, Frei R. Distribution of spa types among meticillin-resistant Staphylococcus aureus isolates during a 6 year period at a low-prevalence University Hospital. J Med Microbiol. 2008;57(Pt 5):612–6.PubMedCrossRefGoogle Scholar
  17. 17.
    Ammerlaan HS, Kluytmans JA, Berkhout H, Buiting A, de Brauwer EI, van den Broek PJ, van Gelderen P, Leenders SA, Ott A, Richter C, Spanjaard L, Spijkerman IJ, van Tiel FH, Voorn GP, Wulf MW, van Zeijl J, Troelstra A, MRSA Eradication Study Group. Eradication of carriage with methicillin-resistant Staphylococcus aureus: effectiveness of a national guideline. J Antimicrob Chemother. 2011;66(10):2409–17.PubMedCrossRefGoogle Scholar
  18. 18.
    Grundmann H, Aanensen DM, van den Wijngaard CC, Spratt BG, Harmsen D, European Staphylococcal Reference Laboratory Working Group. Geographic distribution of Staphylococcus aureus causing invasive infections in Europe: a molecular-epidemiological analysis. PLoS Med. 2010;7(1):e1000215.PubMedCrossRefGoogle Scholar
  19. 19.
    Pan A, Lee A, Cooper B, Chalfine A, Daikos G, Garilli S, Malhotra-Kumar S, Martinez JA, Patroni A, Harbarth S, MOSAR-04 Study Team. Risk factors for previously unknown methicillin-resistant Staphylococcus aureus (MRSA) carriage on admission to 13 surgical wards in Europe. BMC Proc. 2011;5[Suppl 6]:O85.CrossRefGoogle Scholar
  20. 20.
    Tiemersma EW, Bronzwaer SL, Lyytikäinen O, Degener JE, Schrijnemakers P, Bruinsma N, Monen J, Witte W, European Antimicrobial Resistance Surveillance System Participants. Methicillin-resistant Staphylococcus aureus in Europe, 1999–2002. Emerg Infect Dis. 2004;10(9):1627–34.PubMedCrossRefGoogle Scholar
  21. 21.
    Hudson LO, Murphy CR, Spratt BG, Enright MC, Terpstra L, Gombosev A, Hannah P, Mikhail L, Alexander R, Moore DF, Huang SS. Differences in methicillin-resistant Staphylococcus aureus (MRSA) strains isolated from pediatric and adult patients from hospitals in a large California County. J Clin Microbiol. 2012;50(3):573–9.Google Scholar
  22. 22.
    Vindel A, Cuevas O, Cercenado E, Marcos C, Bautista V, Castellares C, Trincado P, Boquete T, Pérez-Vázquez M, Marín M, Spanish Group for the Study of Staphylococcus. Methicillin-resistant Staphylococcus aureus in Spain: molecular epidemiology and utility of different typing methods. J Clin Microbiol. 2009;47(6):1620–7.PubMedCrossRefGoogle Scholar
  23. 23.
    Larsson AK, Gustafsson E, Nilsson AC, Odenholt I, Ringberg H, Melander E. Duration of methicillin-resistant Staphylococcus aureus colonization after diagnosis: a four-year experience from southern Sweden. Scand J Infect Dis. 2011;43(6–7):456–62.PubMedCrossRefGoogle Scholar
  24. 24.
    Ammerlaan HS, Kluytmans JA, Berkhout H, Buiting A, de Brauwer EI, van den Broek PJ, van Gelderen P, Leenders SA, Ott A, Richter C, Spanjaard L, Spijkerman IJ, van Tiel FH, Voorn GP, Wulf MW, van Zeijl J, Troelstra A, MRSA Eradication Study Group. Eradication of carriage with methicillin-resistant Staphylococcus aureus: determinants of treatment failure. J Antimicrob Chemother. 2011;66(10):2418–24.PubMedCrossRefGoogle Scholar
  25. 25.
    Simor AE, Phillips E, McGeer A, Konvalinka A, Loeb M, Devlin HR, Kiss A. 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(2):178–85.PubMedCrossRefGoogle Scholar
  26. 26.
    Marschall J, Muehlemann K. Duration of MRSA-carriage, according to risk factors for acquisition. Infect Control Hosp Epidemiol. 2006;27(11):1206–12.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • P. Kohler
    • 1
  • A. Bregenzer-Witteck
    • 1
  • G. Rettenmund
    • 1
  • S. Otterbech
    • 1
  • M. Schlegel
    • 1
  1. 1.Department of Infectious Diseases and Infection ControlCantonal Hospital St. GallenSt. GallenSwitzerland

Personalised recommendations