WHAT IS MRSA CARRIAGE?The abbreviation MRSA stands for Methicillin-Resistant Staphylococcus aureus . Staphylococcus aureus is a bacterium that occurs in a large part of the Dutch population, without causing any symptoms. This bacterium can become resistant to all kinds of antibiotics such as methicillin, and is then called MRSA.WHERE ON THE BODY CAN MRSA INFECTION OCCUR?MRSA can occur on the skin and in the nose without causing any symptoms. In some people, MRSA can also be found in the throat or intestines. If MRSA is found on the body without causing the person to become ill, this is called MRSA carriage . An MRSA infection is defined as someone developing symptoms or becoming ill from MRSA. MRSA infections are much less common than carriage. These usually involve skin infections, such as impetigo or boils, or wound infections. Infections of the bloodstream, bone, or lungs are very rare.HOW CAN I HAVE BEEN INFECTED WITH MRSA?MRSA is particularly prevalent in foreign hospitals and in livestock (pigs and cows) in the Netherlands. If you have been admitted to a foreign hospital or work with live livestock, you are therefore at increased risk. MRSA can also be contracted in Dutch healthcare institutions. MRSA is primarily transmitted through physical contact, sneezing, or hands. To a lesser extent, MRSA is transmitted by skin flakes that remain in rooms or, for example, on bedding.TREATMENT OF MRSA CARRIAGEThe goal of treatment is to eliminate the MRSA bacteria. Not everyone with MRSA carriage needs treatment. It may be considered if the bacteria repeatedly causes infections, or if it is necessary to work in healthcare. The treatment's likelihood of success and the potential for side effects also play a role in the decision.
Treatment is divided between uncomplicated and complicated carriage . In uncomplicated carriage, the bacteria have established themselves on the skin and in the nose. Treatment consists of washing the skin and hair with special soap, applying an antibiotic ointment to the nose, and a number of hygiene measures. Complicated carriage is defined as the bacteria being found elsewhere (throat, perineum), or if there are skin lesions (eczema, psoriasis, scratches, wounds), or if IVs, catheters, or other lines are present, or if previous treatments using only local agents have failed. The treatment is the same as for uncomplicated carriage, but at the same time you must take antibiotics for a week.Treatment of uncomplicated carriers:Daily (day 1 to 5):
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Apply mupirocin nasal ointment to both nostrils three times a day. Then press the nostrils closed to ensure the ointment is evenly distributed. |
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Wash the hair and the entire body surface with disinfectant soap (chlorhexidine soap solution (brand name: Hibiscrub) or betadine shampoo). This should be done in the shower (not in a bathtub). |
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Clean underwear and clothes once a day. Clean pajamas and/or underwear before bed. |
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Clean washcloths and towels once a day, preferably wash at 60 degrees. |
Day 1, 2 and 5:
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Change your bed linens completely. They should be washed at 60 degrees Celsius. Dry them in a dryer rather than on a clothesline. |
This treatment can also be used for carriers of common staph infections (not MRSA). This is sometimes done in patients with recurring skin infections, such as boils, impetigo, or infected atopic eczema.
If treatment fails, it's important to remember that someone in your household may be infected with the bacteria, and they may also need to be treated. Pets (especially dogs) can also carry staph.Treatment of complicated carrier status:
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The treatment is the same as for uncomplicated carriage, but at the same time you must take antibiotics for 7 days. |
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Typically, two medications are administered simultaneously, often 200 mg doxycycline once daily and 600 mg rifampicin twice daily. Depending on culture results, other antibiotics such as trimethoprim, clindamycin, fusidic acid, clarithromycin, or ciprofloxacin may also be prescribed. |
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If there are any skin abnormalities, such as eczema, psoriasis, scratch marks, or wounds, these should be treated first. |
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If catheters, IVs, or other lines have been inserted, postpone MRSA treatment until they can be removed. |
CHECK CULTURES AFTER TREATMENT
After treatment, it's checked whether the MRSA has truly disappeared. Three cultures are taken, at least one week apart. Only when no MRSA is found in all three cultures can the treatment be considered successful, and the "MRSA-positive" label can be removed from your record. Until then, you are considered a carrier of MRSA, and precautions are taken in the hospital to prevent its spread.
OTHER INFORMATION ABOUT MRSA
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As an MRSA carrier, you may receive visitors at home, but it is wise to ask them to wash their hands upon leaving. Caution is advised for people who are seriously ill, have wounds or skin conditions (such as psoriasis or eczema), or have recently undergone surgery, as they are more likely to contract the MRSA bacteria and become infected. Therefore, consult your doctor if you plan to visit or receive someone who is ill at home. |
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Pregnant women do not have an increased risk of being MRSA carriers and it poses no risk to the unborn child. |
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Even when treated with antibiotics, measures such as washing, changing and using nasal ointment are necessary to maximise the chance of removing the bacteria. |
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The chlorhexidine soap may cause dry skin. This is temporary and will resolve after treatment. You do not need to do anything. However, if you develop a rash, it may indicate a hypersensitivity reaction, and you should contact your doctor. |
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As an MRSA carrier, you can go to work and your children can go to school; you don't need to report it there. If you work in healthcare (hospitals, nursing homes, etc.), different rules apply, and it's best to contact your company doctor. If your partner works in healthcare, the same applies. Children carrying MRSA can go to school. However, if there is an infection, such as MRSA impetigo, it must first be treated with antibiotics for 24 hours. |
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If you need to visit the dentist, you must inform your dentist in advance so they can arrange for the cleaning of the room and equipment. The same applies to any other healthcare providers and institutions you may visit while you are still being treated for MRSA. |
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