Should I be worried about a Methicillin-resistant Staphylococcus aureus (MRSA) recurrence after being treated in 2018?

Should You Be Worried About MRSA Recurrence After Treatment in 2018?

Yes, you should remain vigilant about MRSA recurrence, as approximately 43-50% of patients experience recurrent colonization after initial clearance, with the median time to MRSA clearance being 8.5 months and many patients remaining carriers for up to one year or longer. 1, 2

Understanding Your Risk of Recurrence

Timeline and Persistence

• Half of patients remain MRSA carriers at one year after initial infection, with the estimated median time to complete clearance being 8.5 months 1
• Since your treatment was in 2018 (approximately 6-7 years ago), your risk of still carrying MRSA is substantially lower than in the first year, though not zero 1
• Recurrent colonization occurs in 43.6% of patients after initial clearance, with a median time to recurrence of 53 days (range 36-84 days) 2

Key Risk Factors That Increase Your Concern

You should be more concerned if you have:

• Recent antibiotic use within the last 6 months (approximately doubles your risk of multidrug-resistant bacteria) 1
• Ongoing healthcare contact or antibiotic therapy (prolongs carriage time beyond the 8.5-month median) 1
• Chronic hemodialysis (12% risk of MRSA carriage) 1
• Long-stay hospital admissions (8.6-22% risk of MRSA carriage) 1
• Household members with young children (higher percentage of household members under 18 increases recurrence risk) 2

When to Take Action

You Should Seek Evaluation If:

• You develop new skin infections, boils, or abscesses (signs of active MRSA skin and soft tissue infection) 1
• You experience fever, chills, or signs of systemic infection (could indicate invasive MRSA disease) 1
• You have recurrent skin infections despite good hygiene (may warrant decolonization strategies) 1
• Household members develop similar infections (suggests ongoing transmission) 1

You Generally Do NOT Need Routine Screening If:

• You are asymptomatic with no active infections (routine screening cultures are not recommended) 3
• You have no recurrent infections (surveillance cultures following decolonization are not routinely recommended in absence of active infection) 1, 3
• You have maintained good hygiene without problems (no indication for intervention) 1

Preventive Measures You Should Continue

Essential Hygiene Practices

• Keep any draining wounds covered with clean, dry bandages 3
• Practice hand hygiene with soap and water or alcohol-based gel after touching infected areas 3
• Avoid sharing personal items (towels, razors, clothing) 1, 3
• Clean high-touch surfaces with commercial cleaners regularly 3

When Decolonization May Be Considered

Decolonization is NOT routinely recommended for asymptomatic carriers, but should only be considered if: 3

• You develop recurrent skin infections despite optimizing hygiene measures 3
• There is ongoing transmission among household members despite hygiene interventions 3
• You have multiple recurrent skin and soft tissue infections over a 6-month period 1

Recommended Decolonization Regimen (If Needed)

If decolonization becomes necessary, the approach includes: 1, 3

• Mupirocin 2% ointment to anterior nares twice daily for 5-10 days 3
• Combined with topical body decolonization using chlorhexidine for 5-14 days OR dilute bleach baths 3
• Bleach bath concentration: 1/4 to 1/2 cup bleach per full bathtub (or 1 teaspoon per gallon), for 15 minutes twice weekly for 3 months 1, 3

Important caveat: Mupirocin effectively reduces nasal colonization but has not conclusively been shown to prevent infections in community settings, and high-level mupirocin resistance has been reported in some areas 1, 3

Critical Pitfalls to Avoid

• Do NOT pursue routine screening cultures without symptoms (not recommended and not cost-effective) 1, 3
• Do NOT use oral antibiotics for decolonization routinely (should only be considered in patients who continue to have infections despite other measures, using rifampin-based combinations for 5-10 days) 1
• Do NOT ignore new skin infections (early treatment is essential; progression despite antibiotics could indicate resistant organisms or deeper infection) 1
• Do NOT assume all skin infections are MRSA (but if you develop severe community-acquired infection with fever >39°C, tachycardia, or rapid progression, seek immediate medical attention) 1

Bottom Line for Your Situation

Given that your MRSA treatment was in 2018, you are likely beyond the highest-risk period for recurrence (which occurs within the first year). However, you should:

• Maintain good hygiene practices indefinitely 1, 3
• Seek prompt medical evaluation for any new skin infections 1
• Inform healthcare providers of your MRSA history before procedures or hospitalizations 1
• Consider decolonization only if you develop recurrent infections 3

You do not need routine screening or prophylactic treatment at this time unless you develop symptoms. 3