From the Guidelines
MRSA decolonization should be performed using a comprehensive protocol that includes intranasal mupirocin 2% ointment applied to both nostrils twice daily for 5-7 days, combined with daily chlorhexidine gluconate (CHG) 4% body washes or wipes for 5-7 days, as recommended by the most recent guidelines 1.
Key Components of MRSA Decolonization
- Nasal decolonization with mupirocin twice daily for 5-10 days 1
- Topical body decolonization regimens with a skin antiseptic solution, such as chlorhexidine, for 5-14 days or dilute bleach baths 1
- Environmental decontamination, including washing bedding, towels, and clothing in hot water with bleach if possible
Importance of Decolonization
Decolonization is particularly important for patients with recurrent MRSA infections, those undergoing surgery, or in healthcare settings to prevent transmission 1. Success rates vary, with approximately 60-90% effectiveness immediately after treatment, though recolonization can occur over time.
Recent Guidelines
The most recent guidelines recommend proceeding with nasal decolonization of Staphylococcus aureus (SA) carriage by applying 2% mupirocin in each nostril, associated with a systematic oropharyngeal decontamination by twice-daily mouthwash with chlorhexidine, starting at least 48 h before surgery and for a total duration of 5-7 days, to decrease the occurrence of postoperative infections 1.
From the FDA Drug Label
Mupirocin is active against a wide range of gram-positive bacteria including methicillin-resistant Staphylococcus aureus (MRSA) The FDA drug label does not answer the question.
From the Research
MRSA Decolonization Protocol
The protocol for Methicillin-resistant Staphylococcus aureus (MRSA) decolonization typically involves a combination of topical and oral antimicrobial therapies. The goal of decolonization is to reduce the risk of MRSA infection and prevent transmission to other patients.
Topical Therapies
- Mupirocin 2% ointment applied to the anterior nares 2-3 times/day for 5 days is a commonly used topical therapy for MRSA decolonization 2, 3, 4, 5
- Chlorhexidine gluconate 2% or 4% soap for bathing or showering is also used to decolonize the skin 2, 3, 6, 4, 5
- Povidone-iodine soap and intranasal povidone-iodine may also be used as an alternative decolonization treatment 5
Oral Therapies
- Oral antibiotics such as rifampin and doxycycline or trimethoprim/sulfamethoxazole may be used in conjunction with topical therapies for MRSA decolonization 3, 4
- However, oral antibiotics should be used with caution and only in conjunction with topical agents and when all other decolonization attempts and environmental controls have been exhausted 2
Decolonization Regimens
- A 5-day regimen of mupirocin and chlorhexidine gluconate is a commonly used decolonization protocol 2, 3, 5
- A 7-day regimen of mupirocin, chlorhexidine gluconate, rifampin, and doxycycline has also been shown to be effective in eradicating MRSA colonization 3, 4
- A 6-month regimen of postdischarge hygiene education and decolonization with chlorhexidine and mupirocin has been shown to reduce the risk of MRSA infection in hospitalized patients 6
Efficacy of Decolonization
- The efficacy of MRSA decolonization varies depending on the protocol used and the population being treated 2, 3, 6, 4, 5
- Successful decolonization has been reported in 39-90% of patients treated with various decolonization protocols 3, 4, 5
- Decolonization has been shown to reduce the risk of MRSA infection and prevent transmission to other patients 2, 3, 6, 4, 5