What is the management for a patient with a methicillin-resistant Staphylococcus aureus (MRSA)-positive abscess swab and no symptoms?

Management of Asymptomatic MRSA-Positive Abscess Swab

For patients with a positive MRSA abscess swab but no symptoms, focus on hygiene measures and wound care without routine antibiotic treatment, as decolonization should be reserved for recurrent infections despite optimizing hygiene measures. 1

Initial Management

• Wound care is essential:
  • Keep draining wounds covered with clean, dry bandages 1
  • Ensure proper wound cleaning and drainage is completed 1
  • No systemic antibiotics are needed for asymptomatic colonization 2

Discharge Advice

Personal Hygiene Measures

• Maintain good personal hygiene with regular bathing and cleaning of hands with soap and water or alcohol-based hand sanitizer 1
• Avoid sharing personal items (razors, towels, linens) that may have contacted infected skin 1
• Cover any draining wounds with clean, dry bandages until healed 1

Environmental Hygiene

• Focus cleaning on high-touch surfaces (counters, doorknobs, bathtubs, toilet seats) 1
• Use commercially available cleaners appropriate for the surface being cleaned 1
• Launder clothing, towels, and bedding in hot water 3

When to Consider Decolonization

Decolonization is not routinely recommended for a single MRSA-positive culture without symptoms. It should only be considered if: 1

1. Patient develops recurrent skin and soft tissue infections despite optimizing wound care and hygiene measures
2. Ongoing transmission is occurring among household members despite optimizing hygiene measures

Decolonization Protocol (if needed for recurrent infections)

If decolonization becomes necessary due to recurrent infections:

• Nasal decolonization: Mupirocin ointment applied to nares twice daily for 5-10 days 1, 3
• Skin decolonization: Chlorhexidine body washes daily for 5-14 days or dilute bleach baths (1 teaspoon per gallon of water, 15 minutes twice weekly) 1, 3

Household Contacts Management

• Symptomatic contacts should be evaluated and treated 1
• Asymptomatic household contacts generally don't require decolonization unless there are recurrent infections in the household 1

Follow-up Recommendations

• Provide clear return precautions for worsening symptoms (increasing pain, redness, swelling, fever) 2
• Surveillance cultures following decolonization are not routinely recommended in the absence of active infection 1

Important Caveats

• Success rates for decolonization vary (47-65%) and may be lower with respiratory tract colonization 4, 5
• Decolonization protocols have not consistently shown benefit in preventing recurrent infections in all populations, particularly in pediatric patients 6
• The presence of skin alterations that are MRSA-positive at baseline reduces decolonization success rates (22% vs 50% for MRSA-negative skin alterations) 4

By focusing on hygiene measures and reserving decolonization for recurrent cases, this approach balances the need to prevent transmission while avoiding unnecessary antibiotic use that could contribute to resistance.