CA-MRSA Recurrence

[mknudtson]

We are seeing a fair number of community-acquired methicillin-resistant Staphylococcus aureus skin infections (CA-MRSA) that seem to be recurrent. Are any of you having the patients do a decolonization by having the patients shower at home using chlorhexidine (Hibiclens) or hexachlorophene (pHisoHex) antiseptic soap from head to toe, and apply mupirocin (Bactroban) 2% ointment inside each nostril using a cotton-tipped swab twice daily for 7 days?

[eejjrr]

Don't even bother unless you consider culturing the anterior nares and/or treating family members with the same treatment regime. Even if treated, family members may become re-colonized in the future, but treatment may still be effective in breaking the cycle of recurrent infections. And believe it or not, sometimes family pets (dogs and cats) will also carry MRSA, so if testing of household members is done, pets should be included in the screening process.

Thats a lot of testing/treatment.

Anyway, the nose is what gets colonized. Head to toe chlorhexidine or hexachlorophene has never been indicated and should not be prescribed. Besides, do you think your patients with pets are going to wash their dog's (and God forbid cats) daily with Hibiclens!?!?!?!?

[LindaGee]

According to "The American Journal for Nurse Practitioners" VOL 13 NO 4 April 2009.
"Infectious disease experts recommned decolonizing with topical nasal mupirocin 2% ointment applied to the nares 2-3 times daily for 7-10 days for hte infected patient and for household members or athletic teams in whome a high incidence of MRSA is found. Intermittent use of pHisoHex or pHisoderm soap may reduce the rate of SSTIs, although prolonged use is contraindicated because of toxicity, cost, and development of future resistance. Chlorhexidine 4% soap is highly effective against staphylococci, but its cost may put it out of reach for low income individuals. A less expensive measure for eradication of bacteria colonized on the skin is immersion in tub water containing a half cup of bleach. The CDC reports that colonization occurs at sites other than the nose (eg pharynx, axilla, rectum, perineum ) and that this colonization may be important in terms of the development and transmission of infection or persistence/reappearance of colonization after the use of nasal decolonization agents."

I have had good results preventing reinfection with the bleach solution.