Do you routinely colonize MRSA carriers

N Engl J Med. 2019 Feb 14;380(7):638-650

Contributed by Dr Pruthu Dekane, Dr Abi Manesh

This pragmatic RCT evaluated the benefit of decolonisation along with hygiene education versus education alone in a diverse group of patients who have recently been discharged from the hospital. Participants were assigned in 1:1 ratio to receive either educational materials and proper hygiene (n= 1063) or educational materials plus decolonization routines (n= 1058), including the use of a 4% rinse-off chlorhexidine body wash, 0.12% chlorhexidine mouthwash (to be used twice daily), and 2% nasal mupirocin (to be used twice daily) twice monthly for 6 months. Of course, in view of the rigorous nature of the decolonisation regimen only two thirds could adhere to it.

Researchers found that 98 of 1058 patients (9.2%) in the education group and 67 of 1063 patients (6.3%) in the decolonization group had MRSA infection (HR, 0.70; 95% CI, 0.52 to 0.96; P=0.03 - ARR=0.029; NNT=34.5). Most of these infections are serious ones requiring hospitalisation. Pneumonia, surgical site infection and bacteremic infections were prevented preferentially. The mean duration between enrollment and development of infection in both the groups was about 4 months. The treatment benefit was stronger in the intention to treat group.

Though the event rates were low and treatment effect mild, this could be an useful intervention in select group of patients at high risk for MRSA infections as it prevented serious infections.