February 2008
Volume 18, Issue 2

EIN: Decolonize MRSA Patients or Not?

An Emerging Infections Network (EIN) member in Saudi Arabia asked whether he   should attempt to decolonize a 53-year-old male patient with psoriasis carrying methicillin-resistant Staphylococcus aureus (MRSA). MRSA had once before been eradicated from the patient. His wife and five children were screened and also found  to be carrying MRSA in their noses, although none  had invasive disease. “Should we attempt to eradicate MRSA in everyone in the family?” the EIN member asked.

In general, respondents agreed eradication should not be attempted in this situation. Additional comments from respondents included:

Florida: I would not eradicate the MRSA from the patient or the family unless they are having an invasive procedure that compromises skin integrity…. The patient with psoriasis will likely be colonized as long as his skin disease is active since the numerous skin squames allow for a great niche for MRSA or MSSA colonization.

Also, if there are no active infections then decolonization is unnecessary since 25 percent of the world at any one time has MSSA colonization and 1 percent may have MRSA colonization. Over 50 percent of patients with psoriasis and chronic skin diseases will be colonized with MSSA or MRSA.

Minnesota: I would not. MRSA is quickly becoming part of the human mucosal niche just like MSSA is now. If you screen the family and eradicate the bug from them, what about their neighbors? School mates? Co-workers? The cat is out of the bag.

Tennessee: Mupirocin resistance is [a more] likely outcome than eradication of MRSA…. Hand washing and standard hygienic precautions are the watch words.

Quebec: Decolonization should only be considered in circumstances of recurrent CA-MRSA skin infections defined as two or more in 6 months.

If you choose to decolonize them, go all the way, with two sensitive oral systemic agents, 4 percent chlorhexidine baths daily, and nasal mupirocin tid for 7 days. Remember that pets (dogs/cats) may also carry MRSA in their nares as well. In the community setting, nothing assures you that the initial carrier will not bring it back from school or work in the future.

In my opinion, I think we have arrived in an era when we all have to live with MRSA and not worry about it so much unless we start showing signs of infection. I think that you should reassure him and only try to decolonize him and his family if they start to have symptomatic disease. For now they should just be aware of their status and should inform physicians when they present for infections.

Kentucky: I am using a skin survey after daily bathing on the patient and any household member with [skin and soft tissue infection (SSTI)] history. To any new "lesion" of any kind, topical triple antibiotic cream or ointment [over-the-counter] Neosporin in the US) is applied BID for three days or until all signs are resolved. The trick is getting them to bathe daily and take the time to comply with the survey and topical application, so I [give them] a diagram of the human [body] and ask them to mark the place(s) [with a lesion] on the diagram, put it up in the bathroom, and make a check by it each time they apply the topical. Only two have recurrent lesions and they admit to non-compliance with the survey until the lesions are quite painful. The series is not large enough for statistical significance yet, so please know it is more anecdotal experience currently; however, it has made my call backs from this population much better!

The Emerging Infections Network (EIN) listserve is a forum for infectious diseases consultants and public health officials to report information on clinical phenomena and epidemiological issues with public health significance. Any diagnostic or therapeutic recommendations and all opinions presented are those of the individual contributor. They do not necessarily represent the views of the EIN, the Infectious Diseases Society of America (EIN's sponsor) or the Centers for Disease Control and Prevention, which funds the EIN. The reader assumes all risks in using this information.

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In the IDSA Journals
Europe Reports High Percentage of Oseltamivir-resistant Influenza Virus
EIN: Decolonize MRSA Patients or Not?
Multidrug-resistant Staph Reported among MSM
Health Alerts, Drug Approvals, Recalls, Adverse Events
IDSA Policy & Advocacy Update: IDSA Opposes Anti-Thimerosal Legislation
CDC Survey Shows Less Effective Flu Medications Still Used
Third Seasonal and Pandemic Influenza Meeting: May 18-20
Meeting on Key Issues in TB Drug Development
Welcome, New IDSA Members!
Calendar of Future Meetings and Events
CMS Requires NPI on Claims Starting March 1

Dates to Remember

Oct. 25-29, 2008
IDSA/ICAAC Joint Meeting
Washington, DC
Abstract submission deadline: May 19, 2008

June 3-4, 2008
Fellows' In-Training Exam

Oct. 29-Nov. 1, 2009
47th Annual Meeting of IDSA
Philadelphia, PA


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