MRSA patients: proven methods to treat colonization and infection.

Methicillin-resistant Staphylococcus aureus (MRSA) infections continue to cause serious nosocomial infections in many hospitals. Measures used to control the spread of these infections include ongoing laboratory-based surveillance, placing colonized and infected patients in isolation, use of barrier precautions and handwashing and hand antisepsis. Culturing hospitalized patients at high risk of acquiring MRSA can facilitate detection and isolation of colonized patients. Eradicating MRSA nasal colonization among affected patients and healthcare personnel has also been as a control measure, with variable success. Eradicating MRSA nasal carriage from epidemiologically-implicated healthcare workers has been used on a number of occasions to control outbreaks. Attempts to eradicate MRSA colonization among affected patients has proven difficult. Of more than 40 different decolonization regimens that have been tested during the last 60 years, topical intranasal application of mupirocin ointment has proven to be the most effective. However, intranasal application of mupirocin has limited effectiveness in eradicating colonization in patients who carry the organism at multiple body sites. Furthermore, because decolonization of patients has virtually always been used in combination with other control measures, its efficacy has been difficult to determine. Because MRSA is transmitted primarily on the hands of healthcare workers, greater emphasis should be given to improving hand hygiene practices among health personnel. For patients infected with MRSA, vancomycin remains a drug of choice.