Agents for the decolonization of methicillin-resistant Staphylococcus aureus

Area of Science:

• Infectious Diseases
• Antimicrobial Stewardship
• Clinical Pharmacy

Background:

• Methicillin-resistant Staphylococcus aureus (MRSA) is a significant cause of hospital and community infections.
• Asymptomatic MRSA colonization often precedes invasive infections, highlighting the need for effective decolonization strategies.
• Preventing MRSA transmission and eradicating colonization are crucial for reducing morbidity and mortality.

Purpose of the Study:

• To provide an evidence-based review of available and investigational agents for MRSA decolonization.
• To assess the efficacy and limitations of different decolonization approaches.
• To guide clinical practice in managing MRSA colonization and preventing infection.

Main Methods:

• Comprehensive literature search of Cochrane Central Register, MEDLINE, and EMBASE databases (up to May 2008).
• Inclusion of data from scientific meeting abstracts, manufacturer information, and pharmacology references.
• Focus on topical agents, antiseptic bathing, oral antibiotics, and investigational compounds for MRSA decolonization.

Main Results:

• Mupirocin, applied intranasally, is the most studied agent but resistance development necessitates judicious use.
• Routine decolonization is recommended only upon confirmed MRSA colonization.
• Antiseptic bathing (e.g., chlorhexidine gluconate) combined with nasal mupirocin enhances total body decolonization efficacy.
• Oral antibiotics are a last resort, used adjunctively with topical agents and environmental controls.

Conclusions:

• Mupirocin remains the standard of care for MRSA nasal decolonization.
• Combination therapy, including antiseptic bathing, improves eradication success.
• Further research into alternative and investigational agents is warranted to address MRSA decolonization challenges.