Meticillin-resistant Staphylococcus aureus (MRSA): screening and decolonisation

Abstract

Meticillin-resistant Staphylococcus aureus (MRSA) infections are of increasing importance to clinicians, public health agencies and governments. Prevention and control strategies must address sources in healthcare settings, the community and livestock. This document presents the conclusions of a European Consensus Conference on the role of screening and decolonisation in the control of MRSA infection. The conference was held in Rome on 5-6 March 2010 and was organised jointly by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the International Society of Chemotherapy (ISC). In an environment where MRSA is endemic, universal or targeted screening of patients to detect colonisation was considered to be an essential pillar of any MRSA control programme, along with the option of decolonising carriers dependent on relative risk of infection, either to self or others, in a specific setting. Staff screening may be useful but is problematic as it needs to distinguish between transient carriage and longer-term colonisation. The consequences of identification of MRSA-positive staff may have important effects on morale and the ability to maintain staffing levels. The role of environmental contamination in MRSA infection is unclear, but screening may be helpful as an audit of hygiene procedures. In all situations, screening procedures and decolonisation carry a significant cost burden, the clinical value of which requires careful evaluation. European initiatives designed to provide further information on the cost/benefit value of particular strategies in the control of infection, including those involving MRSA, are in progress.

Differing epidemiology of two major healthcare-associated meticillin-resistant Staphylococcus aureus clones

“…[30][31][32][33][34] Interestingly, CC239 was frequently isolated from patients with CF. Alfred Health is a specialist treatment and referral centre for CF and lung transplant patients.…”

Infection control: Evidence-based common sense

“…Universal screening for MRSA carriage with subsequent decolonisation has almost certainly had a beneficial effect on MRSA carriage and infection rates [14,15]. The MSSA bacteraemia rate might also have decreased, as it has in Australia, if patients had been screened for MSSA as well as for MRSA [14,16].…”

“…Patient screening is not without critique; although heavily defended if the evidence base is challenged [18e21]. The decolonisation programmes offered to carrier patients have also been criticised; for lack of clinical benefit and concern over increasing resistance or tolerance to the agents used in the topical clearance regimens [15,18,22]. Indeed, the current vogue for bathing everyone with antiseptics, notably chlorhexidine, has ignited much discussion with, as yet, no clear decision to help policy makers [23].…”

“…Once again, there is little substantial evidence to support this type of segregation from the infection prevention point of view, while there is evidence to show that isolated patients tend to suffer from loneliness and reduced clinical attention [15,22,24]. Indeed, understaffed wards cannot provide the nursing care required for isolated patients since they are not continually observed.…”

Application of RAPD-PCR for Determining the Clonality of Methicillin Resistant Staphylococcus aureus Isolated from Different Hospitals

“…Widespread emergence of MRSA strains with increasing resistance to a wide range of antibiotics other than methicillin has contributed to the development of clinically serious problems (Neela et al 2005). Therefore, the analysis of the spread of these strains has become a great concern throughout the world (Cookson et al 2011). Phenotypic and genotypic methods have been used to determine the polymorphism among these clinical isolates to follow up nosocomial infections (Singh et al 2006).…”