MRSA - handling after successfull eradication

Question

Hello,
I have a question for the experts. I have been tested positively for MRSA 10 weeks ago, whereupon a sanitation with an antibiotic had been done. Now in the last four sputum samples as well as in one nasal swab no MRSA could be detected anymore.
In spite of this I have problems with my employer, as one speculates, that the MRSA can admittely not be detected, but is neverhteless in the lungs. In CF a permanent eradication would not be possible due to the statements of the public health department.
Are there any clinical studies or experience on this topic?
Many thanks.

Answer

Many thanks for your interesting question, which is indeed not easy to answer. In general it is not true, that it is not possible to eradicate the MRSA permanently, on this topic there are some publications and also we ourselves did sanitate most of the patients permanently from MRSA.

However we are of the opinion, that we only declare our patients really free of MRSA only 6 months after the last investigation is free of MRSA. On this there are however different opinions. For sure not only the sputum and the nasal swab should be negative but also the swab from the inguinal region and also from the armpit should be negative.
Concerning the work, it depends on the kind of work you do. In case you do not have any contact to ill people, you are at least in Switzerland regarded as employable, as many people are carrier of MRSA without knowing it. It is going to be difficult with CF patients, who work in a health care job as here is the risk of transmission of the MRSA to ill people. Here we do not have clear guidelines, partly it is recommended (CF group of Austraila, Brisbane) to wear gloves and face masks during work, this would at least in Switzerland not be possible. Finally this remains really as a decision of the hygiene specialist of the hospital.
I hope to have helped you further with this difficult question and best regards,
Dr. med. Markus Hofer, Zürich

07.07.2009