Treatment of MRSA Nasal Colonization

Introduction to MRSA Nasal Colonization Treatment

The Infectious Diseases Society of America recommends that routine decolonization of asymptomatic MRSA nasal carriers is not recommended, and treatment should be reserved for specific clinical scenarios including recurrent skin infections despite hygiene measures or ongoing household transmission 1, 2, 3

Decolonization should only be considered in situations of recurrent skin and soft tissue infections that persist despite optimizing wound care and hygiene measures, according to the Infectious Diseases Society of America 1, 3
The Infectious Diseases Society of America also recommends considering decolonization in cases of ongoing transmission among household members or close contacts despite hygiene interventions 1, 3
Following treatment of active infection in symptomatic patients, nasal decolonization may be considered, as suggested by the Infectious Diseases Society of America 1, 3

The Infectious Diseases Society of America recommends using mupirocin 2% ointment applied to anterior nares twice daily for 5-10 days as a decolonization regimen 1, 3, 4
For recurrent cases, the Infectious Diseases Society of America suggests a combined decolonization approach with mupirocin 2% ointment to anterior nares twice daily for 5-10 days plus topical body decolonization with chlorhexidine for 5-14 days or dilute bleach baths 1, 3, 4
The bleach bath concentration should be 1/4 to 1/2 cup bleach per full bathtub, as recommended by the Infectious Diseases Society of America 5

The Infectious Diseases Society of America recommends keeping draining wounds covered with clean, dry bandages, and practicing hand hygiene with soap and water or alcohol-based gel after touching infected areas 1, 3
Avoiding sharing personal items and cleaning high-touch surfaces with commercial cleaners is also recommended by the Infectious Diseases Society of America 1, 3
Treating interdigital toe space infections/maceration to reduce colonization reservoirs is suggested by the Infectious Diseases Society of America 5

The Infectious Diseases Society of America recommends evaluating symptomatic contacts and treating active infections first, then considering decolonization 1, 3
Asymptomatic household contacts may be considered for decolonization when ongoing transmission is documented, according to the Infectious Diseases Society of America 1, 3
Recent evidence suggests that treating both patient and household contacts together results in fewer recurrences than treating the patient alone, as reported by the Infectious Diseases Society of America 5

The Infectious Diseases Society of America states that screening cultures are not routinely recommended, and pre-decolonization cultures are unnecessary if prior MRSA infection was documented 2
Post-decolonization surveillance cultures are not recommended in the absence of active infection, according to the Infectious Diseases Society of America 2
The Infectious Diseases Society of America notes that mupirocin effectively reduces nasal colonization but has not conclusively been shown to prevent infections in community settings 2
High-level mupirocin resistance has been reported in some community settings, and prolonged or indiscriminate use should be avoided to prevent resistance development, as warned by the Infectious Diseases Society of America 2, 4