MRSA Decolonization—Is It Feasible?

Abstract

The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) among hospitalized patients is relatively high in many European countries. Many patients are still colonized at the time of discharge and contribute to the growing reservoir of MRSA carriers both inside and outside of hospitals and other healthcare facilities such as nursing homes or rehabilitation hospitals, or even population groups in the community [1]. In order to fight the spread of MRSA, some European countries apply the Dutch “search and destroy” policy. This includes the screening of certain risk groups (search) for MRSA colonization and the eradication of MRSA carriage (destroy) by the application of a decolonization protocol [2]. Typically, such a decolonization protocol includes the application of topical mupirocin ointment to both nares and total body washings with chlorhexidine. The success rate of a decolonization cycle is variable and may be quite low in the presence of wound or lower respiratory tract colonization. Many experts agree that the ideal strategy for MRSA decolonization has not yet been found. Some colleagues even argue that decolonization attempts are a waste of time and resources. Thus, the question whether and how to decolonize MRSA carriers currently awaits a definitive answer. The discussion on the topic of MRSA decolonization is now broadened by the study of Wenisch et al. [3], which we publish in this issue of INFECTION. Under the label of “a holistic approach,” the colleagues from Vienna have lined up all the big and little guns to fight MRSA in critically ill patients with MRSA pneumonia and colonization of the respiratory tract and other body sites. Treatment included systemic linezolid and rifampicin, jet-ventilation with vancomycin, body washing with chlorhexidine, nose treatment with mupirocin, care of the tracheostoma exit site, central venous catheter exit site with polyvidoniodide. The study was conducted in a prospective but non-controlled fashion and included 21 patients. Due to the death of seven patients, only 14 were evaluable, including a follow-up of 2 months. Interestingly, all 14 patients were successfully decolonized and remained free of MRSA at the time of follow-up. Obviously, the uncontrolled nature of the study precludes any definitive conclusions. However, these preliminary data should raise the question, whether a more aggressive approach is needed in patients with infection and/or colonization of the respiratory tract. The study may at least be a starting point for a lively discussion of the topic of MRSA decolonization. Maybe, it will also trigger the inception and design of a prospective-controlled study in a subset of critically ill patients with MRSA infection and colonization.