From the Guidelines
The recommended approach for MRSA decolonization is to use nasal decolonization with mupirocin twice daily for 5–10 days, and consider adding topical body decolonization regimens with a skin antiseptic solution, such as chlorhexidine, for 5–14 days or dilute bleach baths, as outlined in the guidelines by the Infectious Diseases Society of America 1. This approach is based on the most recent and highest quality evidence available, which suggests that decolonization strategies should be offered in conjunction with ongoing reinforcement of hygiene measures. The use of mupirocin and chlorhexidine has been shown to be effective in reducing MRSA colonization, although the optimal regimen, frequency of application, and duration of therapy are unclear 1. Some key points to consider when implementing this approach include:
- Applying mupirocin to both nostrils twice daily for 5-10 days
- Using chlorhexidine gluconate (2-4%) body washes or baths for 5-14 days
- Considering dilute bleach baths, with 1 teaspoon of bleach per gallon of water, for 15 minutes, twice weekly, for 3 months
- Targeting common MRSA reservoirs, including the nares, skin, throat, and perineum
- Emphasizing the importance of ongoing reinforcement of hygiene measures, including covering infected skin and draining wounds, avoiding sharing of personal items, and using commercially available cleaners or detergents for surfaces that come into frequent contact with people's bare skin. It is essential to note that decolonization is particularly important for patients with recurrent MRSA infections, those undergoing certain surgical procedures, and healthcare workers, as it can help prevent auto-infection or transmission 1.
From the Research
MRSA Decolonization Approaches
- The recommended approach for MRSA decolonization involves the use of topical agents, such as mupirocin and chlorhexidine gluconate, to reduce the risk of infection and transmission 2, 3, 4, 5, 6.
- Mupirocin is applied to the anterior nares 2-3 times/day for 5 days, while chlorhexidine gluconate is used for bathing or showering to improve the likelihood of eradication 2, 3, 4.
- Oral antibiotics, such as vancomycin and cotrimoxazole, may be considered in conjunction with topical agents for total body decolonization, but should be used with caution due to the risk of resistance development 2, 4, 5.
Efficacy of Decolonization Regimens
- Studies have shown that decolonization regimens using mupirocin and chlorhexidine gluconate can be highly effective in reducing MRSA colonization and infection risk 3, 4, 5.
- A randomized controlled trial found that postdischarge MRSA decolonization with chlorhexidine and mupirocin led to a 30% lower risk of MRSA infection than education alone 3.
- Another study found that a standardized regimen of mupirocin, chlorhexidine, and oral vancomycin was highly effective in decolonizing MRSA carriers, with a success rate of 87% 4.
Factors Influencing Decolonization Success
- The presence of mupirocin-resistant isolates at baseline has been associated with treatment failure 5.
- The use of mupirocin-based decolonization therapy has been shown to temporarily reduce the risk of continued colonization, but may not decrease the risk of subsequent infection 6.
- Other factors, such as residence in a long-term care facility and the presence of a pressure ulcer, may also influence the risk of sustained colonization and infection 6.