69 Effectiveness of MRSA decolonization regimens 4 Decolonization treatment In 131 patients systemic antibiotic treatment was prescribed (Figure 1), and in 125/131 (95%) the choice of antibiotic regimen was in line with the national guideline (Table 1). Six patients received antimicrobial combinations that were not in line with the guideline and 4 others were initially treated with hygienic measures and topical therapy only. The success rate of the first decolonization attempt was 97/131 (74%). Not all patients that failed on a first treatment were treated again. Of the 34 patients in whom the first decolonization attempt failed, 17/34 (50%) underwent a second treatment (Table 3). The success rate after this second treatment was 11/17 (65%). Of the remaining six patients, four were treated for a third time, which was successful in 3/4 (75%) of patients. The cumulative success rate was 111/131 (85%). Mean follow-up time was 13 months. In 78/111 (70%) of the initially successfully treated patients follow-up cultures at T≥12 months were available. In 4/78 (5%) of patients these cultures were positive for MRSA. Side effects were reported in 27/131 (21%) of patients and consisted of gastrointestinal complaints (21/131; 16%) and malaise (4/131; 3%). An allergic reaction occurred in 1 of the 131 patients. Figure 1 (next page). Flowchart of treatment schedule. Uncomplicated MRSA carriership was defined as the presence of all of the following features: (i) 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, external fixation material), and (vi) no previous failure of decolonization treatment. All other cases were considered complicated. Successful decolonization was defined by three successive negative MRSA swabs from nose, throat, and perineum at least 48 h after treatment, with a minimum interval of 1 week. An asterisk (*) indicates that colonization was accepted under certain circumstances, e.g., active noncurable skin lesions, short life expectancy, wishes of the patient, or a high risk of recurrence due to frequent livestock contact or regular visits to health care facilities abroad. An arrowhead indicates patients added to another group.
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