Staphylococcus aureus decolonization
From IDWiki
- Staphylococcus aureus is commonly found in the nares and on the skin of healthy people
- Asymptomatic colonization is associated with a higher rate of invasive infection
Project CLEAR
- Probably has the best evidence 1
- Decolonization happens for 5 days, twice monthly, for 6 months
- 4% rinse-off chlorhexidine for daily bathing or showering
- 0.12% chlorhexidine mouthwash twice daily
- 2% nasal mupirocin twice daily
- NNT of about 30 to prevent one infection or one hospitalization
Dutch Method
- Also has some evidence 2
- Separates patients into uncomplicated (essentially entirely asymptomatic carriage in a low-risk patient) and complicated
Uncomplicated carriage
- Topical treatment (5 days)
- Mupirocin 2% to nares q8h
- Chlorhexidine or povidone iodide soap applied once daily
- Hygienic measures
- Clean underwear, clothing, washcloths and towels daily
- Change bedsheets every other day during treatment
Complicated carriage
- As above, plus oral antibiotics
- TMP-SMX (200 mg twice a day) + rifampin (600 mg twice a day) for 1 week
References
- ^ Susan S. Huang, Raveena Singh, James A. McKinnell, Steven Park, Adrijana Gombosev, Samantha J. Eells, Daniel L. Gillen, Diane Kim, Syma Rashid, Raul Macias-Gil, Michael A. Bolaris, Thomas Tjoa, Chenghua Cao, Suzie S. Hong, Jennifer Lequieu, Eric Cui, Justin Chang, Jiayi He, Kaye Evans, Ellena Peterson, Gail Simpson, Philip Robinson, Chester Choi, Charles C. Bailey, James D. Leo, Alpesh Amin, Donald Goldmann, John A. Jernigan, Richard Platt, Edward Septimus, Robert A. Weinstein, Mary K. Hayden, Loren G. Miller. Decolonization to Reduce Postdischarge Infection Risk among MRSA Carriers. New England Journal of Medicine. 2019;380(7):638-650. doi:10.1056/nejmoa1716771.
