Management of Asymptomatic MRSA Nasal Colonization
For asymptomatic patients with positive MRSA nasal swabs, no specific treatment is routinely recommended unless there is a history of recurrent skin infections or ongoing household transmission. 1
Assessment of Need for Decolonization
Decolonization therapy should be considered in the following specific scenarios:
- Patient has a history of recurrent MRSA skin and soft tissue infections (SSTIs) despite optimizing wound care and hygiene measures 1
- There is ongoing MRSA transmission among household members or close contacts despite optimizing hygiene measures 1
- Patient is at high risk for subsequent MRSA infection (e.g., upcoming surgery, immunocompromised) 2
Recommended Decolonization Protocol
When decolonization is indicated, the following evidence-based regimen should be used:
- Nasal decolonization: Mupirocin 2% ointment applied to both anterior nares twice daily for 5-10 days 1, 3
- Body decolonization: Consider adding chlorhexidine gluconate (CHG) body wash or dilute bleach baths 1, 4
- For CHG: Daily bathing with 2% CHG for 5-14 days
- For 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
Hygiene Measures for All MRSA Carriers
All patients with MRSA colonization should be instructed on the following hygiene measures:
- Maintain good personal hygiene with regular bathing 1
- Clean hands frequently with soap and water or alcohol-based hand sanitizer, especially after touching potentially contaminated items 1
- Avoid sharing personal items that contact skin (e.g., razors, towels, bedding) 1
- Clean high-touch household surfaces regularly with standard cleaning products 1
Household Contact Management
- Symptomatic contacts should be evaluated and treated for possible MRSA infection 1
- Asymptomatic household contacts may be considered for decolonization if there is ongoing transmission within the household 1, 5
Monitoring and Follow-up
- Routine surveillance cultures following decolonization are not recommended in the absence of active infection 1
- Screening cultures prior to decolonization are not routinely needed if at least one prior infection was documented as MRSA 1
Special Considerations
- In healthcare settings or long-term care facilities, asymptomatic MRSA carriers should not be refused admission 5
- During a facility outbreak, more aggressive measures including isolation and decolonization of carriers may be warranted 5, 6
- Patients with high adherence to decolonization protocols have significantly lower rates of subsequent MRSA infection (44% reduction) compared to those receiving education alone 2
Potential Pitfalls
- Widespread use of mupirocin can lead to resistance development; therefore, decolonization should be reserved for appropriate indications 3
- Chlorhexidine and mupirocin may cause mild skin irritation in approximately 4% of patients 2
- Hexachlorophane should not be used in children under 2 months of age due to risk of neurological complications 1
- Decolonization may only provide temporary clearance, with recolonization occurring after discontinuation 1