Consultant. Vol. 48 No. 13

Pages: 1 2 3

Prevention of Recurrent MRSA Skin Infections: What You Need to Know

By STEVEN C. BUCKINGHAM, MD
University of Tennessee | December 1, 2008

Dr Buckingham is associate professor of pediatrics, in the division of infectious disease, at University of Tennessee Health Science Center in Memphis, and he is affiliated with the Children’s Foundation Research Center at Le Bonheur Children’s Medical Center, also in Memphis.

RECOMMENDATIONS
Recurrent staphylococcal skin infections are frustrating for patients, their families and their health care providers. It is understandable that clinicians wish to prescribe something for these patients in the hope of preventing further recurrences. Unfortunately, the published evidence to date does not clearly demonstrate that any topical, systemic, or intranasal therapy—or any combination of the three—is effective for this purpose.

This lack of evidence notwithstanding, clinicians continue to recommend various combinations of decolonization therapies for patients with recurrent skin infections. The potential adverse consequences of such actions are 3-fold:
•Patients are exposed to possible side effects.
•The threat of antimicrobial resistance is increased.
•Money is spent on interventions that are unproved.

Some additional disadvantages of specific popular agents for staphylococcal decolonization are summarized in the Table.

RCTs with large sample sizes are needed to determine the optimal regimen for preventing recurrent MRSA skin infections—assuming that an optimal regimen exists. Future studies along these lines should incorporate intent-to-treat analyses of clinical (number of skin infections) rather than microbiologic (percentage with negative intranasal cultures) outcome measures.

Until an optimal decolonization regimen is identified—or a safe and immunogenic S aureus vaccine is available—hygiene is likely to remain the cornerstone of efforts to prevent recurrent skin infections (see Box). In particular, hand hygiene should be promoted to all affected patients and their families. Frequent hand washing (with plain soap) and the use of alcohol(Drug information on alcohol)-based waterless hand sanitizers are safe and inexpensive measures with proven value in preventing illness transmission within households.^14,16,17

Therapeutic Agents Mentioned in This Article:
Clindamycin(Drug information on clindamycin)* (Cleocin)
Chlorhexidine(Drug information on chlorhexidine) gluconate (Bactoshield, Exidine, Dyna-Hex, Hibiclens, Hibistat)
Doxycycline(Drug information on doxycycline)* (Periostat, Adoxa, Atridox, Doryx, Oracea, Monodox, Vibramycin, Doxyhexal)
Hexachlorophene (pHisoHex, Septisol)
Minocycline* (Dynacin, Myrac, Soldyn, Minocin, Arestin)
Mupirocin* (Bactroban)
Povidone-iodine* (Acu-dyne, Aerodine, Betadine, Betagen, Biodine, Etodine, Iodex, Mallisol, Minidyne, Operand, Polydine, Povidine)
Rifampin* (Rifadin, Rimactane)
Trimethoprim(Drug information on trimethoprim)/sulfamethoxazole* (Bactrim, Cotrim, Septra, Sulfatrim, Tribrissen)
*Available in generic formulation

Pages: 1 2 3

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EVIDENCE-BASED MEDICINE:
• Aiello AE, Larson EL, Levy SB. Consumer antibacterial soaps: effective or just risky? Clin Infect Dis. 2007;45(suppl 2):S137-S147.
• Boyce JM, Pittet D; Healthcare Infection Control Practices Advisory Committee; HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Guideline for hand hygiene in health-care settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/ IDSA Hand Hygiene Task Force. MMWR Recomm Rep. 2002;51(RR-16):1-45.
• Loeb M, Main C, Walker-Dilks C, Eady A. Antimicrobial drugs for treating methicillin-resistant Staphylococcus aureus colonization. Cochrane Database Syst Rev. 2003;(4):CD003340.
• Tacconelli E, Carmeli Y, Aizer A, et al. Mupirocin prophylaxis to prevent Staphylococcus aureus infection in patients undergoing dialysis: a meta-analysis. Clin Infect Dis. 2003;37:1629-1638.
• van Rijen MM, Bonten M, Wenzel RP, Kluytmans JA. Intranasal mupirocin for reduction of Staphylococcus aureus infections in surgical patients with nasal carriage: a systematic review. J Antimicrob Chemother. 2008;61:254-261.

TOPIC INDEX

Developmental/Genetic

Nutritional/Metabolic

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Prevention of Recurrent MRSA Skin Infections: What You Need to Know

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