Prevention Of Recurrent MRSA Skin Infections: What You Need To Know

Main Category: MRSA / Drug Resistance
Article Date: 07 Jan 2009 - 4:00 PST

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Clinicians often prescribe topical, intranasal, or systemic antimicrobial agents to patients with recurrent skin infections caused by methicillin-resistant Staphylococcus aureus (MRSA) in an effort to eradicate the staphylococcal carrier state. Some agents can temporarily interrupt staphylococcal carriage, but none has been proved effective for prevention of skin infections caused by MRSA. Extant data do not support the routine prescription of topical antiseptics or of intranasal or systemic antibiotics for the prevention of MRSA skin infections. Hygienic interventions, especially frequent hand washing with plain soap and the use of alcoholbased hand sanitizers, remain the cornerstone of efforts to prevent recurrent infections.

Methicillin-resistant Staphylococcus aureus (MRSA) was once considered a strictly nosocomial pathogen. Over the past decade, however, MRSA has emerged as a prominent cause of community-associated infections in both adults and children. Although community-associated MRSA strains occasionally cause severe invasive infections, they are most frequently isolated from patients with skin and soft tissue infections. Furunculosis ("boils") is the most frequently reported manifestation of communityassociated MRSA skin infection, but impetigo, pustulosis, cellulitis, and locally invasive abscesses have also been described.

The tendency of staphylococcal skin infections to recur is well recognized. Data on the frequency of recurrence, however, are sparse. In a study of 69 children who were treated for MRSA skin or soft tissue abscesses, 12% had a history of previous cutaneous abscesses.3 Other studies, which principally involved men with HIV infection, documented recurrences of MRSA skin infections in 31% to 45% of subjects.

In the absence of an effective S aureus vaccine, many clinicians recommend various topical, intranasal, or systemic antimicrobial agents for patients with recurrent MRSA skin infections in an effort to "decolonize" them of MRSA. However, there is scant evidence that decolonization strategies actually prevent recurrent MRSA skin infections. In this article, I discuss some of the most popular decolonization strategies and review the evidence regarding their safety and effectiveness.

STEVEN C. BUCKINGHAM, MD

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