Management of Nasal Colonization of Gram-Positive Bacilli

Indications for Treatment

The Infectious Diseases Society of America recommends against routine decolonization of asymptomatic carriers, but treatment may be indicated for recurrent skin and soft tissue infections, ongoing household transmission, pre-operative screening and decolonization, or following treatment of active infection 1
Treatment should only be pursued in specific scenarios, including recurrent skin and soft tissue infections that persist despite optimizing wound care and hygiene measures 1, 3
Ongoing household transmission among close contacts despite hygiene interventions is another indication for treatment 1, 3
Pre-operative screening and decolonization before high-risk surgeries, such as cardiothoracic or orthopedic surgeries, is also recommended 4, 5

The European Society of Clinical Microbiology and Infectious Diseases recommends intranasal mupirocin 2% ointment applied to both anterior nares twice daily for 5-10 days as the primary decolonization regimen 1, 2, 3
For patients with persistent recurrences, a combination of mupirocin with body decolonization using chlorhexidine gluconate 2% body wash or dilute bleach baths may be effective 1, 2, 3

Decolonization fails without concurrent hygiene interventions, including keeping draining wounds covered, practicing hand hygiene, avoiding sharing personal items, and cleaning high-touch surfaces 1, 3
Treating interdigital toe space infections or maceration is also essential to eliminate colonization reservoirs 1

Treating both the patient and household contacts together results in fewer recurrences than treating the patient alone 1, 3
Asymptomatic household contacts may be considered for decolonization only when ongoing transmission is documented despite hygiene measures 1, 3

High-level mupirocin resistance has been reported in some S. aureus strains, and prolonged or indiscriminate use promotes resistance without clinical benefit 1, 2, 3
Recolonization occurs in 40-60% of patients within 3 months after decolonization, and mupirocin may not conclusively prevent infections in community settings 1, 3