24 Chapter 2 Abstract The Dutch ‘search and destroy’ policy consists of screening patients with an increased risk of methicillin-resistant Staphylococcus aureus (MRSA) carriership and subsequent decolonization treatment when carriership is found. Decolonization therapy of individual MRSA carriers is effective. However, the effectiveness of the national ‘search and destroy’ policy is dependent on the entire cascade of care, including identification, referral, and subsequent treatment initiation in MRSA carriers. The aim of this study was to evaluate the leakages in the cascade of MRSA decolonization care. We assessed familiarity with the ‘search and destroy’ policy and the barriers in the uptake of MRSA eradication care using a questionnaire among 114 Dutch general practitioners. The main reasons for treatment were planned hospital visits, occupational reasons, and infections. The main reasons for refraining from eradication treatment were unfamiliarity with the ‘search and destroy’ policy and the assumption that MRSA carriership is often self-limiting. To optimize the continuity of the cascade of care, interventions should be aimed at supporting general practitioners and facilitating treatment and referral. Introduction Antimicrobial resistance is a global health threat that causes millions of deaths [1]. The WHO has declared that antimicrobial resistance is one of the top ten global public health threats facing humanity [2]. Methicillin-resistant Staphylococcus aureus (MRSA) is a major actor in the field of antimicrobial resistance. In 2019, 100.000 deaths and 3.5 million disability-adjusted life-years (DALYs) were attributable to infections with MRSA [3]. Colonization with MRSA leads to increased infection rates of up to 25% [4–6]. Colonization and infection rates are known to vary throughout the world. Historically, in the Netherlands, MRSA infection rates are low. Less than 5% of invasive Staphylococcus aureus isolates are resistant to methicillin. Together with the Nordic European countries, the Dutch prevalence of MRSA is the lowest in the world [7]. The estimated nasal colonization rate in the Dutch population is 0.03–0.17%, compared to 0.9–1.5% in the US [8]. The healthcare system in the Netherlands has executed a national ‘search and destroy’ policy since 1988, which is outlined in the guidelines of the Dutch Working Party on Infection Prevention (WIP) [9]. The policy consists of the screening and preemptive isolation of patients with an increased risk of MRSA carriership when hospitalized
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