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When Should You Decolonize Methicillin-Resistant Staphylococcus aureus (MRSA) in Hospitalized Patients?

The Hospitalist. 2014 November;2014(11):
November 2, 2014 | The Hospitalist
Karen Clarke, MD, MPH, MS, FHM, FACP

Back to the Case

The patient in this case required admission to an ICU and, based on the results of the REDUCE MRSA clinical trial, she would likely benefit from undergoing decolonization to reduce her risk of both MRSA-positive clinical cultures and bloodstream infections caused by any pathogen.

Bottom Line

Decolonization is beneficial for patients at increased risk of developing a MRSA infection during a specific period, such as patients admitted to the ICU and those undergoing cardiothoracic surgery.

Dr. Clarke is assistant professor in the division of hospital medicine at Emory University Hospital and a faculty member in the Emory University Department of Medicine, both in Atlanta.

Key Points

  • Decolonization is a temporary measure; it does not permanently eradicate MRSA.
  • Data do not support the routine use of decolonization in nonsurgical patients, except for those undergoing dialysis.
  • Patients who derive the most benefit from decolonization are those at increased risk for developing a MRSA infection during a specific time interval, such as those admitted to the ICU and cardiothoracic surgery patients.

Additional Reading

  • Hebert C, Robicsek A. Decolonization therapy in infection control. Curr Opin Infect Dis. 2010;23(4):340-345.
  • Abad CL, Pulia MS, Safdar N. Does the nose know? An update on MRSA decolonization strategies. Curr Infect Dis Rep. 2013;15(6):455-464.
  • McConeghy KW, Mikolich DJ, LaPlante KL. Agents for the decolonization of methicillin-resistant Staphylococcus aureus. Pharmacotherapy. 2009;29(3):263-280.
  • Kallen AJ, Jernigan JA, Patel PR. Decolonization to prevent infections with Staphylococcus aureus in patients undergoing hemodialysis: A review of current evidence. Semin Dial. 2011;24(5):533-539.

References

  1. 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.
  2. Simor AE. Staphylococcal decolonisation: An effective strategy for prevention of infection? Lancet Infect Dis. 2011;11(12):952-962.
  3. Huang SS, Septimus E, Kleinman K, et al. Targeted versus universal decolonization to prevent ICU infection. N Engl J Med. 2013;368(24):2255-2265.
  4. Fraser T, Fatica C, Scarpelli M, et al. Decrease in Staphylococcus aureus colonization and hospital-acquired infection in a medical intensive care unit after institution of an active surveillance and decolonization program. Infect Control Hosp Epidemiol. 2010;31(8):779-783.
  5. Robotham J, Graves N, Cookson B, et al. Screening, isolation, and decolonisation strategies in the control of methicillin-resistant Staphylococcus aureus in intensive care units: Cost effectiveness evaluation. BMJ. 2011;343:d5694.
  6. Schweizer M, Perencevich E, McDanel J, et al. Effectiveness of a bundled intervention of decolonization and prophylaxis to decrease Gram positive surgical site infections after cardiac or orthopedic surgery: Systematic review and meta-analysis. BMJ. 2013;346:f2743.

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