25 Barriers in the uptake of MRSA ‘search and destroy’ 2 and subsequent decolonization treatment when persistent carriership is found [10– 12]. Examples of an increased risk are preceding events such as hospitalization in a country where MRSA is endemic, or a confirmed MRSA-carrying household contact. The aim of the policy, which is endorsed by the Dutch health council, is to keep the MRSA prevalence and the associated disease burden low [13]. Cost-effectiveness was confirmed in the years thereafter, with an estimated saving of up to EUR 400 per hospital per year [10,14]. As part of this ‘search and destroy’ policy, decolonization treatment in MRSA carriers has proven to be an effective preventive strategy in reducing infection and hospitalization rates [15]. The success rate of decolonization treatment, defined as three consecutive negative MRSA swabs from nose, throat, and perineum, is as high as 86% [16]. However, the effectiveness of the policy is also dependent on the initial identification of carriership and the initiation of treatment. Therefore, the effectiveness of the national policy relies on the correct execution of several consecutive steps in a so-called cascade of care and involves several healthcare professionals. In HIV care, a similar approach was taken and led to the clarification of the culprits in the uptake of combination anti-retroviral therapy (cART) [17]. Following this example, this approach was applied to tuberculosis and hepatitis C [18,19]. We hypothesize that the same approach is applicable to MRSA decolonization care as well (Figure 1). Within the MRSA decolonization cascade of care, individuals may be lost, which is referred to as leakage, and is analogous to the cART roll-out strategies. Understanding at which steps this leakage occurs will provide information to optimize MRSA eradication strategies [20]. The aim of our current study was to evaluate the leakages within the cascade of MRSA decolonization care and the main reasons for them. We carried out a questionnaire study amongst general practitioners (GPs) to gain insight into their familiarity with the ‘search and destroy’ policy and to evaluate barriers in the uptake of MRSA eradication care. The knowledge generated will help to determine specific targets that can be addressed to keep MRSA prevalence low and to contribute to a reduced burden of antimicrobial resistance.
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