53 Eradication of community-onset MRSA carriage 3 Discussion and conclusion MRSA decolonization has been proven to reduce infections in both patients and healthy individuals. However, determining eligible treatment candidates and applying experiences and results from countries with low MRSA prevalence to countries with high MRSA prevalence continue to be challenging. In general, eradication studies in high prevalence areas are hampered by the indistinguishability of failing eradication treatment vs. recolonization. The likelihood of successful long-term decolonization is lower in a high endemicity setting compared with a low endemicity setting, because of the heightened risk of recolonization (Figure 2). Thus, both treatment goal (short-term bacterial load reduction in health care settings vs. long-term eradication in community settings), and likelihood of successful prolonged eradication should guide the eligibility for CO-MRSA decolonization treatment in the individual patient. Although highly effective in decolonization of nasal MRSA carriage, the combination of mupirocin and antiseptic body wash appears to be insufficient in patients with extra-nasal MRSA colonization. The addition of systemic antibiotics is a rational approach in this patient category, but studies on systemic treatment of extranasal MRSA decolonization are subject to a high heterogeneity of treatment agents and comparator groups. Most evidence support a combination of topical therapy with rifampin and another antimicrobial agent for extra-nasal MRSA eradication. Future research would gain clinical applicability from reporting the carrier status of household contacts, long-term follow-up cultures, and reporting genotyping in case of failure. Eradication treatment with probiotics holds promise as a novel nonantibiotic strategy.
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