Objective: Eradication treatment of MRSA carriers has been controversial due to reports of a high degree of re-lapses and the risk for development of mupirocin resistance.In the county of North Jutland, Denmark all MRSA cases has been offered eradication treatment since 2000. In this paper we present the experience of eradication treatment obtained during the 8 year period 2000-20007
METHODS: From 1st January 2000 – 31th December 2007, all MRSA positive individuals in county of North Jutland were offered eradication treatment. Treatment was mupirocin x3/day in the nares and chlorhexidine bodywash x1 daily for 5 days in combination with advice for cleaning of environment. For community associ-ated cases the whole household was treated. In case of failure treatment was repeated ± supplemented with sys-temic antibiotic (two antibiotics, based on resistance pattern). Full follow up included >=3 swabs one at minimum 6 months after end of eradication treatment. Success was defined as full follow up and continued negative at the 6 months control.
Results: A total of 215 cases were offered treatment. 10 died before completion of treatment and further 34 refused, or failed to comply with the eradication treatment leaving 171 evaluable cases. Success was obtained in 135 (79%) cases, in 6 cases eradication treatment failed and 30 cases await 6 months control. Of the 135 cases 17 had to have one or more systemic treatment to be successful. Tonsil carriage was found in 70 cases. Success was obtained for 55 cases (78%), 6 cases failed and 9 cases await 6 months control. The majority of cases need-ing systemic treatment had throat carriage, however, 38 (69%) of the 55 cases with throat carriage was cleared without systemic treatment. Only one imported mupirocin resistant isolate was found in the eight year period – this patient was cleared using fusidic acid nasal creme and Chlorhexidin bodywash.
Conclusion: In 79% of evaluable cases successful long term clearance of MRSA carriage was obtained by eradi-cation treatment. All 5 cases with failure had tonsil carriage and persons with tonsil carriage more often needed systemic treatment, however, 38 of 55 cases with tonsil carriage was successfully treated with mupirocin and chlorhexidine bodywash only.