Eradication of carriage with methicillin-resistant Staphylococcus aureus: effectiveness of a national guideline

Heidi S. M. Ammerlaan; Jan A. J. W. Kluytmans; Hanneke Berkhout; Anton Buiting; Els I. G. B. de Brauwer; Peterhans J. van den Broek; Paula van Gelderen; Sander (A.) C. A. P. Leenders; Alewijn Ott; Clemens Richter; Lodewijk Spanjaard; Ingrid J. B. Spijkerman; Frank H. van Tiel; G. Paul Voorn; Mireille W. H. Wulf; Jan van Zeijl; Annet Troelstra; Marc J. M. Bonten

doi:10.1093/jac/dkr243

Eradication of carriage with methicillin-resistant Staphylococcus aureus: effectiveness of a national guideline

Heidi S. M. Ammerlaan^*, Jan A. J. W. Kluytmans, Hanneke Berkhout, Anton Buiting, Els I. G. B. de Brauwer, Peterhans J. van den Broek, Paula van Gelderen, Sander (A.) C. A. P. Leenders, Alewijn Ott, Clemens Richter, Lodewijk Spanjaard, Ingrid J. B. Spijkerman, Frank H. van Tiel, G. Paul Voorn, Mireille W. H. Wulf, Jan van Zeijl, Annet Troelstra, Marc J. M. Bonten

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background: We evaluated the effectiveness of eradication of methicillin-resistant Staphylococcus aureus (MRSA) carriage in the Netherlands after the introduction of a guideline in 2006. The guideline distinguishes complicated (defined as the presence of MRSA infection, skin lesions, foreign-body material, mupirocin resistance and/or exclusive extranasal carriage) and uncomplicated carriage (not meeting criteria for complicated carriage). Mupirocin nasal ointment and chlorhexidine soap solution are recommended for uncomplicated carriers and the same treatment in combination with two oral antibiotics for complicated carriage. Methods: A prospective cohort study was performed in 18 Dutch centres from 1 October 2006 until 1 October 2008. Results: Six hundred and thirteen MRSA carriers underwent one or more decolonization treatments during the study period, mostly after hospital discharge. Decolonization was achieved in 367 (60%) patients with one eradication attempt and ultimately 493 (80%) patients were decolonized, with a median time until decolonization of 10 days (interquartile range 7-43 days). Three hundred and twenty-seven (62%) carriers were treated according to the guideline, which was associated with an absolute increase in treatment success of 20% [from 45% (91/203) to 65% (214/327)]. Conclusions: Sixty percent of MRSA carriers were successfully decolonized after the first eradication attempt and 62% were treated according to the guideline, which was associated with an increased treatment success.

Original language	English
Pages (from-to)	2409-2417
Journal	Journal of Antimicrobial Chemotherapy
Volume	66
Issue number	10
DOIs	https://doi.org/10.1093/jac/dkr243
Publication status	Published - Oct 2011

Keywords

colonization
treatment
decolonization
success
Dutch guideline

Access to Document

10.1093/jac/dkr243

Cite this

Ammerlaan, H. S. M., Kluytmans, J. A. J. W., Berkhout, H., Buiting, A., de Brauwer, E. I. G. B., van den Broek, P. J., van Gelderen, P., Leenders, S., Ott, A., Richter, C., Spanjaard, L., Spijkerman, I. J. B., van Tiel, F. H., Voorn, G. P., Wulf, M. W. H., van Zeijl, J., Troelstra, A., & Bonten, M. J. M. (2011). Eradication of carriage with methicillin-resistant Staphylococcus aureus: effectiveness of a national guideline. Journal of Antimicrobial Chemotherapy, 66(10), 2409-2417. https://doi.org/10.1093/jac/dkr243

@article{1d6eecb3f1c34a0bb875f3d77d2caa5d,

title = "Eradication of carriage with methicillin-resistant Staphylococcus aureus: effectiveness of a national guideline",

abstract = "Background: We evaluated the effectiveness of eradication of methicillin-resistant Staphylococcus aureus (MRSA) carriage in the Netherlands after the introduction of a guideline in 2006. The guideline distinguishes complicated (defined as the presence of MRSA infection, skin lesions, foreign-body material, mupirocin resistance and/or exclusive extranasal carriage) and uncomplicated carriage (not meeting criteria for complicated carriage). Mupirocin nasal ointment and chlorhexidine soap solution are recommended for uncomplicated carriers and the same treatment in combination with two oral antibiotics for complicated carriage. Methods: A prospective cohort study was performed in 18 Dutch centres from 1 October 2006 until 1 October 2008. Results: Six hundred and thirteen MRSA carriers underwent one or more decolonization treatments during the study period, mostly after hospital discharge. Decolonization was achieved in 367 (60%) patients with one eradication attempt and ultimately 493 (80%) patients were decolonized, with a median time until decolonization of 10 days (interquartile range 7-43 days). Three hundred and twenty-seven (62%) carriers were treated according to the guideline, which was associated with an absolute increase in treatment success of 20% [from 45% (91/203) to 65% (214/327)]. Conclusions: Sixty percent of MRSA carriers were successfully decolonized after the first eradication attempt and 62% were treated according to the guideline, which was associated with an increased treatment success.",

keywords = "colonization, treatment, decolonization, success, Dutch guideline",

author = "Ammerlaan, {Heidi S. M.} and Kluytmans, {Jan A. J. W.} and Hanneke Berkhout and Anton Buiting and {de Brauwer}, {Els I. G. B.} and {van den Broek}, {Peterhans J.} and {van Gelderen}, Paula and Leenders, {Sander (A.) C. A. P.} and Alewijn Ott and Clemens Richter and Lodewijk Spanjaard and Spijkerman, {Ingrid J. B.} and {van Tiel}, {Frank H.} and Voorn, {G. Paul} and Wulf, {Mireille W. H.} and {van Zeijl}, Jan and Annet Troelstra and Bonten, {Marc J. M.}",

year = "2011",

month = oct,

doi = "10.1093/jac/dkr243",

language = "English",

volume = "66",

pages = "2409--2417",

journal = "Journal of Antimicrobial Chemotherapy",

issn = "0305-7453",

publisher = "Oxford University Press",

number = "10",

}

Ammerlaan, HSM, Kluytmans, JAJW, Berkhout, H, Buiting, A, de Brauwer, EIGB, van den Broek, PJ, van Gelderen, P, Leenders, S, Ott, A, Richter, C, Spanjaard, L, Spijkerman, IJB, van Tiel, FH, Voorn, GP, Wulf, MWH, van Zeijl, J, Troelstra, A & Bonten, MJM 2011, 'Eradication of carriage with methicillin-resistant Staphylococcus aureus: effectiveness of a national guideline', Journal of Antimicrobial Chemotherapy, vol. 66, no. 10, pp. 2409-2417. https://doi.org/10.1093/jac/dkr243

TY - JOUR

T1 - Eradication of carriage with methicillin-resistant Staphylococcus aureus: effectiveness of a national guideline

AU - Ammerlaan, Heidi S. M.

AU - Kluytmans, Jan A. J. W.

AU - Berkhout, Hanneke

AU - Buiting, Anton

AU - de Brauwer, Els I. G. B.

AU - van den Broek, Peterhans J.

AU - van Gelderen, Paula

AU - Leenders, Sander (A.) C. A. P.

AU - Ott, Alewijn

AU - Richter, Clemens

AU - Spanjaard, Lodewijk

AU - Spijkerman, Ingrid J. B.

AU - van Tiel, Frank H.

AU - Voorn, G. Paul

AU - Wulf, Mireille W. H.

AU - van Zeijl, Jan

AU - Troelstra, Annet

AU - Bonten, Marc J. M.

PY - 2011/10

Y1 - 2011/10

N2 - Background: We evaluated the effectiveness of eradication of methicillin-resistant Staphylococcus aureus (MRSA) carriage in the Netherlands after the introduction of a guideline in 2006. The guideline distinguishes complicated (defined as the presence of MRSA infection, skin lesions, foreign-body material, mupirocin resistance and/or exclusive extranasal carriage) and uncomplicated carriage (not meeting criteria for complicated carriage). Mupirocin nasal ointment and chlorhexidine soap solution are recommended for uncomplicated carriers and the same treatment in combination with two oral antibiotics for complicated carriage. Methods: A prospective cohort study was performed in 18 Dutch centres from 1 October 2006 until 1 October 2008. Results: Six hundred and thirteen MRSA carriers underwent one or more decolonization treatments during the study period, mostly after hospital discharge. Decolonization was achieved in 367 (60%) patients with one eradication attempt and ultimately 493 (80%) patients were decolonized, with a median time until decolonization of 10 days (interquartile range 7-43 days). Three hundred and twenty-seven (62%) carriers were treated according to the guideline, which was associated with an absolute increase in treatment success of 20% [from 45% (91/203) to 65% (214/327)]. Conclusions: Sixty percent of MRSA carriers were successfully decolonized after the first eradication attempt and 62% were treated according to the guideline, which was associated with an increased treatment success.

AB - Background: We evaluated the effectiveness of eradication of methicillin-resistant Staphylococcus aureus (MRSA) carriage in the Netherlands after the introduction of a guideline in 2006. The guideline distinguishes complicated (defined as the presence of MRSA infection, skin lesions, foreign-body material, mupirocin resistance and/or exclusive extranasal carriage) and uncomplicated carriage (not meeting criteria for complicated carriage). Mupirocin nasal ointment and chlorhexidine soap solution are recommended for uncomplicated carriers and the same treatment in combination with two oral antibiotics for complicated carriage. Methods: A prospective cohort study was performed in 18 Dutch centres from 1 October 2006 until 1 October 2008. Results: Six hundred and thirteen MRSA carriers underwent one or more decolonization treatments during the study period, mostly after hospital discharge. Decolonization was achieved in 367 (60%) patients with one eradication attempt and ultimately 493 (80%) patients were decolonized, with a median time until decolonization of 10 days (interquartile range 7-43 days). Three hundred and twenty-seven (62%) carriers were treated according to the guideline, which was associated with an absolute increase in treatment success of 20% [from 45% (91/203) to 65% (214/327)]. Conclusions: Sixty percent of MRSA carriers were successfully decolonized after the first eradication attempt and 62% were treated according to the guideline, which was associated with an increased treatment success.

KW - colonization

KW - treatment

KW - decolonization

KW - success

KW - Dutch guideline

U2 - 10.1093/jac/dkr243

DO - 10.1093/jac/dkr243

M3 - Article

C2 - 21719473

SN - 0305-7453

VL - 66

SP - 2409

EP - 2417

JO - Journal of Antimicrobial Chemotherapy

JF - Journal of Antimicrobial Chemotherapy

IS - 10

ER -