MRSA colonisation (eradicating colonisation in people without active invasive infection)

Methicillin-resistant Staphylococcus aureus (MRSA) contains a gene that makes it resistant to methicillin as well as to other beta-lactam antibiotics, including flucloxacillin, cephalosporins, and carbapenems. MRSA can be part of the normal body flora (colonisation), especially in the nose, but it can cause infection. Until recently, MRSA has primarily been a problem associated with exposure to the healthcare system, especially in people with prolonged hospital admissions or underlying disease, or after antibiotic use. In many countries worldwide, a preponderance of S aureus bloodstream isolates are resistant to methicillin.

We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of treatment for MRSA nasal or extra-nasal colonisation in adults? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview).

At this update, searching of electronic databases retrieved 850 studies. After deduplication and removal of conference abstracts, 356 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 273 studies, and the further review of 83 full publications. Of the 83 full articles evaluated, no studies were added at this update. We performed a GRADE evaluation for three PICO combinations.

In this systematic overview, we categorised the efficacy for five interventions based on information about the effectiveness and safety of antiseptic body washes, chlorhexidine-neomycin nasal cream, mupirocin nasal ointment, systemic antimicrobials, and other topical antimicrobials.