Abstract：
BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) colonization increases infection risk in both patients and healthy individuals. Decolonization therapy has been proven to reduce S. aureus infections, but data on the effectiveness of individual decolonization strategies in community-onset MRSA carriage are scarce.
OBJECTIVE: The aim of this narrative review was to summarize the evidence on strategies for the elimination of MRSA colonization in community-onset MRSA carriers.
METHODS: PubMed database was searched for studies on MRSA eradication, from inception to July 2023.
BACKGROUND: Topical therapy is proven to be effective in nasal-only carriage and in temporary load reduction. Mupirocin nasal ointment in combination with chlorhexidine body wash is highly effective in nasal-only MRSA carriers in the community as well. In patients with extra-nasal colonization, addition of orally administered antibiotics likely increases success rates compared with topical therapy alone. Studies on systemic treatment of extra-nasal MRSA decolonization are subject to a high heterogeneity of antimicrobial agents, treatment duration, and control groups. The majority of evidence supports the use of a combination of topical therapy with rifampin and another antimicrobial agent. Decolonization treatment with probiotics is a promising novel non-antibiotic strategy. However, achieving long-term decolonization is more likely in countries with low MRSA prevalence, given the risk of recolonization in a context of high MRSA prevalence.
CONCLUSIONS: The decision to pursue community-onset MRSA eradication treatment in the individual patient should be based on the combination of the treatment objective (short-term bacterial load reduction in health care settings vs. long-term eradication in community settings), and the likelihood of successful decolonization. The latter is influenced by both individual risk factors for treatment failure, and the risk of recolonization. The addition of a combination of systemic antibiotics is rational for extra-nasal long-term decolonization. To determine the most effective systemic antimicrobial agents in MRSA decolonization, more research is needed.
OBJECTIVE: The aim of this narrative review was to summarize the evidence on strategies for the elimination of MRSA colonization in community-onset MRSA carriers.
METHODS: PubMed database was searched for studies on MRSA eradication, from inception to July 2023.
BACKGROUND: Topical therapy is proven to be effective in nasal-only carriage and in temporary load reduction. Mupirocin nasal ointment in combination with chlorhexidine body wash is highly effective in nasal-only MRSA carriers in the community as well. In patients with extra-nasal colonization, addition of orally administered antibiotics likely increases success rates compared with topical therapy alone. Studies on systemic treatment of extra-nasal MRSA decolonization are subject to a high heterogeneity of antimicrobial agents, treatment duration, and control groups. The majority of evidence supports the use of a combination of topical therapy with rifampin and another antimicrobial agent. Decolonization treatment with probiotics is a promising novel non-antibiotic strategy. However, achieving long-term decolonization is more likely in countries with low MRSA prevalence, given the risk of recolonization in a context of high MRSA prevalence.
CONCLUSIONS: The decision to pursue community-onset MRSA eradication treatment in the individual patient should be based on the combination of the treatment objective (short-term bacterial load reduction in health care settings vs. long-term eradication in community settings), and the likelihood of successful decolonization. The latter is influenced by both individual risk factors for treatment failure, and the risk of recolonization. The addition of a combination of systemic antibiotics is rational for extra-nasal long-term decolonization. To determine the most effective systemic antimicrobial agents in MRSA decolonization, more research is needed.
摘要：
背景：耐甲氧西林金黄色葡萄球菌（MRSA）定植增加了患者和健康个体的感染风险。非殖民化疗法已被证明可以减少金黄色葡萄球菌感染，但是关于社区型MRSA携带中个体非殖民化策略的有效性的数据很少.
目的：这篇叙述性综述旨在总结消除社区型MRSA携带者MRSA定植策略的证据。
方法：在Pubmed数据库中搜索关于MRSA根除的研究，从成立到2023年7月。
背景：事实证明，局部治疗在仅鼻腔携带和暂时减轻负荷方面是有效的。莫匹罗星鼻用软膏与氯己定沐浴液联合使用对社区中仅鼻MRSA携带者也非常有效。在鼻外定植的患者中，与单独的局部治疗相比,口服抗生素可能会增加成功率.关于鼻外MRSA脱色的全身治疗的研究受到抗菌药物高度异质性的影响，治疗持续时间,和对照组。大多数证据支持使用局部治疗与利福平和另一种抗微生物剂的组合。益生菌的去殖民地治疗是一种有前途的新型非抗生素策略。然而,在MRSA患病率较低的国家，实现长期非殖民化的可能性更大，考虑到在MRSA高患病率的情况下重新定殖的风险。
结论：在个体患者中进行社区型MRSA根除治疗的决定应基于治疗目标的组合（医疗机构的短期细菌负荷减少与社区环境的长期根除）。以及非殖民化成功的可能性。后者受治疗失败的个体风险因素的影响，和重新殖民的风险。全身性抗生素的组合的添加对于鼻外长期脱色是合理的。为了确定MRSA脱色中最有效的全身抗菌剂，需要更多的研究。
目的：这篇叙述性综述旨在总结消除社区型MRSA携带者MRSA定植策略的证据。
方法：在Pubmed数据库中搜索关于MRSA根除的研究，从成立到2023年7月。
背景：事实证明，局部治疗在仅鼻腔携带和暂时减轻负荷方面是有效的。莫匹罗星鼻用软膏与氯己定沐浴液联合使用对社区中仅鼻MRSA携带者也非常有效。在鼻外定植的患者中，与单独的局部治疗相比,口服抗生素可能会增加成功率.关于鼻外MRSA脱色的全身治疗的研究受到抗菌药物高度异质性的影响，治疗持续时间,和对照组。大多数证据支持使用局部治疗与利福平和另一种抗微生物剂的组合。益生菌的去殖民地治疗是一种有前途的新型非抗生素策略。然而,在MRSA患病率较低的国家，实现长期非殖民化的可能性更大，考虑到在MRSA高患病率的情况下重新定殖的风险。
结论：在个体患者中进行社区型MRSA根除治疗的决定应基于治疗目标的组合（医疗机构的短期细菌负荷减少与社区环境的长期根除）。以及非殖民化成功的可能性。后者受治疗失败的个体风险因素的影响，和重新殖民的风险。全身性抗生素的组合的添加对于鼻外长期脱色是合理的。为了确定MRSA脱色中最有效的全身抗菌剂，需要更多的研究。
