77 Effectiveness of MRSA decolonization regimens 4 In the current search and destroy strategy, MRSA carriers are exposed to systemic antibiotic therapy, for the benefit of society, even if they are asymptomatic. The side-effects of treatment should be weighed against the benefits of a search and destroy policy. Reported side effects in this study were mild and the effectivity of decolonization high, supporting the current that MRSA decolonization strategy in a low prevalence country like the Netherlands. There are several limitations of our study. Due to its observational design, confounding limits the determination of the most effective antibiotic strategy. However, so far there is only one small randomized trial published comparing the efficacy of ciprofloxacin-rifampicin and trimethoprim-sulfamethoxazole combinations in MRSA decolonization. This study showed no significant difference in success rates, but did not include a doxycycline based regimen and was underpowered [14]. The majority of previously published studies are limited to the comparison of different antibiotic combinations versus topical treatment alone or no treatment at all [15, 17]. A second limitation of our study is that group sizes are small due to the low prevalence of MRSA colonization and the variety of different antibiotic regimens that were prescribed, reflecting the current guideline. A third limitation is that a proportion of patients were lost to follow-up one year after treatment. However, only 5% of the initially successfully treated patients that were cultured after one year were recolonized with MRSA. In the study of Lekkerkerk et al. [23], the median number of days to detect a MRSA recurrence was 24 and 12% of recurrences was detected between 62 and 200 days. Therefore, the majority of recurrences is expected to have been detected in our study, but late recurrences may have been missed. However, these late recurrences could also be ascribed to re-colonization from an unidentified source rather than to failure of the initial decolonization treatment. In conclusion, treatment for complicated MRSA colonization according to the guideline has a high success rate. These findings endorse the current strategy of ‘search and destroy’. For future research, a randomized trial would be necessary to further distinguish whether doxycycline-rifampicin has a higher efficacy rate compared to alternative treatment combinations, as suggested in this study.
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