29 Barriers in the uptake of MRSA ‘search and destroy’ 2 Table 1. The attitude of GPs towards indication for treatment of MRSA carriership. Frequency n/n (%) Indication for eradication treatment In all MRSA carriers 18/114 (16) In selected cases 58/114 (51) Planned/expected hospital visits 58/58 (100) Infections with MRSA 42/58 (72) Occupational reason (e.g., healthcare worker) 52/58 (90) Patients’ request 10/58 (17) In none of the MRSA carriers 1/114 (1) Unknown 37/114 (32) Reasons to refrain from treatment * Potential self-limiting nature of MRSA carriership 57/96 ** (59) Unfamiliarity with the policy 24/96 (25) Treatment burden for patients 22/96 (23) Lack of recommendation in the GP guideline 17/96 (18) Patients’ request 17/96 (18) Absence of benefit for the patient 11/96 (11) Sense of incompetence to guide a treatment 10/96 (10) Absence of benefit for the society 5/96 (5) Costs for the patient 4/96 (4) Other *** 19/96 (20) Legend: Indications for MRSA eradication according to Dutch general practitioners and reasons not to initiate treatment or refer for treatment. * Multiple answers possible. ** Eighteen GPs who answered in the previous question that all MRSA carriers have an indication for eradication treatment were not asked for reasons to refrain from treatment. *** Other reasons mentioned in free text: not a task for the GP, assumption of no curation, never considered, patient in palliative setting. GP = general practitioner. Forty-four respondents (44/114, 39%) had treated patients with (complicated or uncomplicated) MRSA carriership themselves—in all cases or in selected cases. When treating a patient for MRSA carriership, 10/44 (23%) of the responding GPs included the screening and treatment of household contacts in the initial treatment attempt, 5/44 (11%) included the household contacts only after a failed treatment attempt, and 12/44 (27%) never included household contacts. Other GPs (17/44, 39%) stated that they asked an expert for advice. The most important reasons to refrain from referring an MRSA carrier to the hospital were unfamiliarity with the existence of MRSA outpatient clinics (55/114, 48%), feeling competent in the self-performance of treatment (19/114, 17%), and the absence of this recommendation in the guideline (17/114, 15%) (Table 2).
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