What is the treatment for Methicillin-resistant Staphylococcus aureus (MRSA) colonization?

Treatment of MRSA Colonization

For MRSA colonization, the recommended treatment is nasal decolonization with mupirocin ointment twice daily for 5-10 days, combined with topical body decolonization using chlorhexidine skin antiseptic solution for 5-14 days or dilute bleach baths. 1

When to Consider Decolonization

Decolonization should be considered in the following scenarios:

1. Patients with recurrent MRSA skin and soft tissue infections (SSTIs) despite optimizing wound care and hygiene measures 1
2. When ongoing transmission is occurring among household members or close contacts despite hygiene measures 1
3. Before high-risk surgeries such as cardiothoracic and orthopedic procedures in patients colonized with S. aureus (including MRSA) 1

Decolonization Protocol

Standard Protocol Components:

• Nasal decolonization: Mupirocin ointment applied to nares twice daily for 5-10 days 1
• Body decolonization: Choose one of the following:
  • Chlorhexidine skin antiseptic solution for 5-14 days 1
  • Dilute bleach baths (1 teaspoon per gallon of water or ¼ cup per ¼ tub/13 gallons) for 15 minutes twice weekly for up to 3 months 1

For Specific Colonization Sites:

• Intestinal colonization: May require oral vancomycin 2
• Urinary tract colonization: May require cotrimoxazole 2
• Vaginal colonization: May require povidone-iodine, chlorhexidine ovula, or octenidine solution 2

Additional Hygiene Measures

These should be implemented concurrently with decolonization:

1. Personal hygiene:

   • Regular bathing with soap and water 1
   • Hand hygiene with soap and water or alcohol-based hand sanitizer, especially after touching infected skin 1
   • Avoid sharing personal items (razors, linens, towels) 1

2. Environmental hygiene:

   • Focus cleaning on high-touch surfaces (counters, doorknobs, bathtubs, toilet seats) 1
   • Use commercially available cleaners according to label instructions 1

3. Wound care:

   • Keep draining wounds covered with clean, dry bandages 1

Efficacy and Outcomes

• The combination of nasal mupirocin and chlorhexidine bathing has shown a 30% reduction in MRSA infection risk compared to education alone 3
• Full adherence to decolonization protocols can reduce MRSA infections by up to 44% 3
• Standardized decolonization regimens can achieve success rates of 87-98% when completed properly 2

Important Considerations

• Screening: Routine screening cultures before decolonization are not recommended if at least one prior infection was documented as MRSA 1
• Surveillance: Post-decolonization surveillance cultures are not routinely recommended in the absence of active infection 1
• Resistance concerns: Increased use of mupirocin correlates with resistance development; therefore, decolonization should only be performed when MRSA colonization is confirmed 4
• Household contacts: Consider evaluating household contacts for MRSA colonization when there is ongoing transmission 1
• Surgical prophylaxis: For MRSA carriers undergoing cardiothoracic or orthopedic surgery, consider adding vancomycin to standard surgical prophylaxis 1

Treatment Failure

If initial decolonization fails, consider:

1. Repeating the decolonization protocol
2. Adding systemic antibiotics (particularly for extra-nasal colonization)
3. Using combination therapy with rifampin and another antimicrobial agent for persistent colonization 5

The evidence strongly supports this comprehensive approach to MRSA decolonization, which can significantly reduce infection risk and transmission when properly implemented.