Although the Dutch system of "search and destroy" has given the Netherlands one of the lowest rates of MRSA colonization and infection, testing everyone in a hospital for MRSA and subsequently treating is not generally recommended. Numerous studies have advocated colonization screening and mupirocin decolonization for outbreaks, but it has not been proven to reduce infections in endemic areas. This study from Kauffman, et al is widely cited and makes a few key points:
1) reduction of MRSA colonization is not necessarily correlated to reduction of MRSA infection in facilities without high infection rates
2) mupirocin resistance is increasing with prolonged use
3) intranasal mupirocin is only an effective decolonizer if all other colonized areas of the body are treated with mupirocin as well
Mupirocin is widely used, especially in dermatology, for recurrent superficial infections and wound healing in high-risk individuals. It will be interesting to follow the trend of mupirocin resistance amongst strains of MRSA. Mupirocin is by far the most effective agent in decolonization although new medications are under review. There are two types of mupirocin resistance, high-level (plasmid-mediated) and low-level (still mupirocin susceptible at the commonly used dosage). High-level resistance is most concerning and was shown to increase with widespread mupirocin use in the above study.
Kauffman CA, Bradley SF, Terpenning MS. Methicillin-resistant Staphylococcus aureus in long-term care facilities. Infect Control Hosp Epidemiol. 1990;11:600–603.
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