Methicillin-resistant Staphylococcus aureus: the persistent resistant nosocomial pathogen.

Since the first reports of outbreaks in hospitals in the United States, the prevalence of MRSA colonization and infection has increased in acute-care and chronic-care facilities, outpatient clinics, and in the community. Because of the morbidity and mortality associated with MRSA infections, their preventable nature, and the current requirement for treatment with vancomycin, it is reasonable to invest resources into controlling the transmission of MRSA. Transmission occurs primarily from colonized or infected patients to others via the hands of health care personnel. Efforts to prevent the occurrence of new cases are centered around active or passive surveillance to identify the existing patient reservoir of MRSA and the institution of control measures to block transmission from this reservoir. These measures include hand disinfection, barrier precautions, and segregation of colonized patients. Education and feedback of data to medical personnel are also of value. Health care workers with MRSA colonization are associated with transmission only in a minority of instances. Generally, no treatment is indicated. When eradication of the carrier state is warranted, in personnel or in patients, topical mupirocin ointment appears to be the most effective agent for eliminating nasal carriage. When systemic therapy is required for carriage, rifampin in combination with TMP/SMX or may possibly with Novobiocin be used if the isolate is susceptible. Vancomycin is currently the drug of choice to treat infections due to MRSA, but it does not eradicate carriage. New agents to treat MRSA infections are in various phases of clinical trials.