27 Barriers in the uptake of MRSA ‘search and destroy’ 2 and uncomplicated carriership, and eradication therapy. Two case vignettes were included to assess daily practice (Box 1). The target population consisted of GPs in the Netherlands. The questionnaire was hosted on Formdesk, a web-based survey platform, and was distributed via different networks of GPs and newsletters from participating hospitals. The majority of the recipients were situated in the western part of the Netherlands. There was the possibility of responding anonymously. The questionnaire was accessible between 7 March 2022 and 13 June 2022. Descriptive statistics were used to summarize the data derived from the Formdesk software. Box 1. Case vignettes. Legend: Two clinical case vignettes were included in the questionnaire. Case A describes a patient with uncomplicated carriership. Case B describes a patient with complicated carriership. The guideline recommends treatment with topical therapy in case A and treatment with additional (systemic) antibiotics in case B. Definitions The Dutch national guideline on the treatment of MRSA carriers recommends different eradication treatments depending on the type of carriership. Uncomplicated MRSA carriership is defined as having all of the following features: (i) the presence of MRSA exclusively located in the nose, (ii) no active infection with MRSA, (iii) in vitro sensitivity for mupirocin, (iv) the absence of active skin lesions, (v) the absence of foreign material that connects an internal body site with the outside (e.g., urine catheter or external fixation material), and (vi) no previous failure of decolonization treatment. All other cases are considered to be complicated colonization [21]. Uncomplicated carriership is treated with topical therapy (mupirocin topically applied to the nares and disinfecting shampoo) and hygienic measures. In the case of complicated MRSA carriage, additional systemic antimicrobial therapy with a combination of two antibiotic agents is recommended. Furthermore, the guideline recommends the screening of household contacts (and sometimes pets) and the simultaneous treatment of colonized household contacts [21]. Case A: A 26 years-old healthy male was admitted in the hospital during a holiday in Spain because of a trauma. After returning in the Netherlands, you perform culture swabs from, throat and perineum. The nasal culture is positive for MRSA. There are no skin lesions. There are no hospital visits planned. Case B: A 56 years-old male with a history of heart failure and chronic kidney disease, was screened for MRSA carriership by you following a hospital admission. He is MRSA positive in nose, throat and perineum.
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