Methicillin-resistant Staphylococcus aureus (MRSA) colonization in patients with spinal cord injury

Methicillin-resistant Staphylococcus aureus (MRSA) colonization has been a problem in the Rancho Los Amigos Medical Center (RLAMC) since 1978. This study reviews the latest 2 years' use of a protocol to prevent the spread of MRSA while allowing spinal cord injured patients to continue to participate in the rehabilitation program. The protocol included management in a private room, bathing with hexachlorophene, monitoring positive sites and clearing patients after 3 weeks of negative cultures. Clusters of cases were investigated by obtaining nasal cultures from the personnel. Sixty-seven of 584 (11%) SCI patients were colonized from July 1989 to July 1991. The prevalence of MRSA colonization was significantly greater in the pressure ulcer management service (PMS) 49/184 (27%) than in the rehabilitation spinal injury service (SIS) 18/400 (5%). The body sites colonized were wounds (58/67), nares (37/67), throat (30/67), urine (27/67) and perineum (17/67). Oral therapy with combinations of sulfamethoxazole trimethoprim (SXT) or Novobiocin with rifampin together with topical antibiotics (nares and wound sites), used in nine patients with healing wounds or recent flap surgery, resulted in clearing of the colonization in all cases. Identification and treatment of carriers in the personnel and use of preadmission screening cultures for MRSA in patients with pressure ulcers resulted in reduced inpatient admission.