At what age should we decolonize our little germ bots? A retrospective study of MRSA decolonization in children under 6 years old

Reviewed by Jen Cihlar, DO, Vanderbilt University Medical Center

Bottom line: In Denmark, as part of a nationwide effort to reduce MRSA infections, national guidelines recommend everyone is screened with decolonization treatment of carriers and household contacts however, a “wait and see” approach to decolonization currently used for children <2 years since 2012 may also be appropriate for children ages 2- 6 years old.

A national guideline in Demark to reduce MRSA cases has recommended decolonization treatment of carriers and all household contacts, until 2012 when a “wait and see” approach was granted to MRSA positive children <2 years old, though this age group is still screened 1-2 times annually until 2 years. In this retrospective study (Jan 2007 – Aug 2021), the authors used time-to-event analyses to compare the probability of becoming MRSA free with and without decolonization in children <2 years old compared to those ages 2-5 years to evaluate if the “wait and see” approach is also appropriate for this upper age group.  Being “MRSA free” was defined as after one MRSA negative sample at least 6 months after treatment or if following the wait-and-see approach, one negative screening set. Univariable Cox regression comparing the effect of the age group and of decolonization treatment showed no larger effect of decolonization treatment vs no treatment in the <2 year olds (HR 0.97, p=0.91) or in 2-5 year old (HR 0.62, p=0.078) with similar multivariable regression findings and interestingly the 2-5 year old became MRSA free faster than <2 year olds (HR 1.86, p=0.011), similar in multivariate analysis (HR 1.81, p=0.059). Helbo and colleagues suggested that a “wait-and-see” approach for all children <6 years old might be appropriate and more studies need to be done to help determine when older children start to resemble the adult population regarding natural history of MRSA colonization and response to decolonization.

Helbo T, Boel JB, Bartels MD, Ahlström MG, Holzknecht BJ, Eriksen HB. Carriage of methicillin-resistant Staphylococcus aureus in children <6 years old: a retrospective follow-up study of the natural course and effectiveness of decolonization treatment. J Antimicrob Chemother. 2024;79(4):826-834. doi:10.1093/jac/dkae036

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