From the Guidelines
Methicillin-resistant Staphylococcus aureus (MRSA) decolonization is indicated for patients with recurrent skin and soft tissue infections (SSTI) despite optimizing wound care and hygiene measures, or when there is ongoing transmission among household members or close contacts. The decision to decolonize should be made on a case-by-case basis, considering the individual's risk factors and the potential benefits and harms of decolonization 1.
Key Considerations
- Decolonization may be considered for patients with recurrent MRSA infections, particularly those with a history of SSTI despite optimal wound care and hygiene measures 1.
- Ongoing transmission among household members or close contacts is another indication for decolonization 1.
- The standard decolonization regimen includes nasal decolonization with mupirocin twice daily for 5-10 days, and may also include topical body decolonization regimens with a skin antiseptic solution, such as chlorhexidine, for 5-14 days or dilute bleach baths 1.
Decolonization Regimens
- Nasal decolonization with mupirocin twice daily for 5-10 days is a recommended regimen 1.
- Topical body decolonization regimens with a skin antiseptic solution, such as chlorhexidine, for 5-14 days or dilute bleach baths may also be effective 1.
- The use of oral antibiotics, such as rifampin, for decolonization is not recommended due to the lack of evidence and potential risks, including the development of antimicrobial resistance 1.
Monitoring and Follow-up
- Follow-up cultures 1-2 weeks after completing the decolonization regimen are recommended to confirm successful decolonization 1.
- Repeat treatment may be considered if cultures remain positive after the initial decolonization attempt 1.
From the FDA Drug Label
Mupirocin is active against a wide range of gram-positive bacteria including methicillin-resistant Staphylococcus aureus (MRSA). The indications for Methicillin-resistant Staphylococcus aureus (MRSA) decolonization are not explicitly stated in the provided drug labels.
- The labels mention the drug's activity against MRSA, but do not provide information on its use for decolonization. 2 2
From the Research
Indications for MRSA Decolonization
The indications for Methicillin-resistant Staphylococcus aureus (MRSA) decolonization include:
- Reducing the risk of MRSA infection in individual carriers, particularly those undergoing elective surgery 3
- Preventing transmission to other patients 4, 3
- Decreasing MRSA disease burden in certain patient populations, such as those with nasal and extra-nasal carriage of MRSA 4, 5
- Reducing postdischarge infection risk among MRSA carriers, especially those who have been hospitalized 6
Patient Populations
MRSA decolonization may be beneficial for the following patient populations:
- Hospitalized patients who are colonized with MRSA 4, 6
- Patients undergoing elective surgery 3
- Patients with community-onset MRSA carriage 5
- Patients with a history of MRSA infection or colonization 7
Decolonization Strategies
Various decolonization strategies have been studied, including:
- Topical therapy with mupirocin nasal ointment and chlorhexidine body wash 4, 5, 6
- Application of intranasal povidone-iodine and washing with povidone-iodine soap 4
- Use of systemic antibiotics, such as rifampin, in combination with topical therapy 5
- Decolonization treatment with probiotics as a novel non-antibiotic strategy 5