Healthcare workers with confirmed methicillin-resistant Staphylococcus aureus (MRSA) carriage often experience negative consequences, such as work restrictions, long-term sick leave, repeated failed attempts at eradication, stigmatisation and psychosocial stress. We describe two students who, after several unsuccessful attempts at eradication, underwent tonsillectomy to rid themselves of throat carriage.
Methicillin-resistant Staphylococcus aureus (MRSA) was found in the throat swabs of one medical student and one nursing student. Screening samples from skin lesions, the nose and perineum were negative. Both students were tested after travel abroad, in line with the regulation on medical testing prior to clinical practice in healthcare institutions (1). MRSA was confirmed in PCR analyses, and the bacterial isolates were sensitive to all antibiotics tested, except benzylpenicillin and oxacillin. Both students were healthy with no risk factors for prolonged carriage, and they were highly motivated in relation to eradication. The students had studied different subjects in different time periods and had no knowledge of each other.
The household members in both families were tested several times. All tested negative for MRSA, except for one close contact who tested positive for MRSA in the nose and perineum with the same antibiogram. The first attempt at eradication in this close contact was successful, and in subsequent checks, all cultures were negative.
The students received follow-up at the Outpatient Clinic for Infectious Diseases in collaboration with the hospital’s senior consultant in infection control. Eradication was performed using mupirocin nasal ointment three times daily, daily chlorhexidine whole body wash and a series of measures in the home, including the daily changing of towels and bed linen for 7–10 days. To address the throat carriage, two different oral antibiotics were prescribed in accordance with susceptibility testing. Multiple attempts were made at eradication, but these failed to eliminate MRSA carriage.
Student no. 1 had four attempts at eradication, using three different combinations of oral antibiotics over a total of two years and 11 months: doxycycline 100 mg × 2 and rifampicin 450 mg × 2, followed by ciprofloxacin 750 mg × 2 and rifampicin 450 mg × 2. The third attempt was with trimethoprim-sulfamethoxazole in tablet form 2 + 2 and rifampicin 450 mg × 2, and the fourth attempt with ciprofloxacin 750 mg × 2 and rifampicin 450 mg × 2. Throat swabs detected recurrent MRSA after 8, 51, 5 and 4 weeks, respectively.
Student no. 2 had two attempts at eradication with two different combinations of oral antibiotics over two months: ciprofloxacin 750 mg × 2 and rifampicin 450 mg × 2 in tablet form as the first course of treatment, followed by doxycycline 100 mg × 2 and rifampicin 450 mg × 2. Recurrent MRSA was found in the throat swabs after two and three weeks, respectively. No further attempts at eradication were made due to adverse effects of medication and rapid relapses.
All antibiotic courses covered a ten-day period, except for the first course in student no. 1, which was seven days.
The students found the period with repeated unsuccessful attempts at eradication to be very stressful, and they had concerns about their social life, their studies/clinical placements, the reduced opportunities to work alongside their studies, and future career options. Effective communication with both the clinical placement institution and the study programme coordinator facilitated the students’ adaptation of their studies and clinical placements, ensuring completion within the standard time frame.
Tonsillectomy has been proposed as a possible treatment strategy for persistent MRSA throat carriage (2–4). The Department of Otolaryngology was consulted, and after several well-informed discussions about potential complications, such as bleeding and infection, the decision was made to perform tonsillectomy on both students approximately four years and one year after the initial positive MRSA test.
The procedures were performed according to the standard protocol for general anaesthesia with intubation, with no complications. Cultures of excised tonsil tissue confirmed the presence of MRSA in both students. Multiple follow-up samples from the nose, oropharynx and both tonsil beds were negative in repeated culture checks, with the last one approximately 12 months postoperatively. Throat carriage is now considered to have successfully been eradicated in both students.
The students have consented to publication of this article.
The article has been peer-reviewed.
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