Assessment
Establish Carriage Decolonisation Definitions
- Recurrence
- Recurrence is defined by the clinical context i.e., several episodes may be required to lead to action if minor clinical problem, however two episodes may be acted on if there is significant consequence or co-morbidity. The issue is recurrent seeding of the skin with Staphylococcus aureus secondary to carriage, most commonly in the nose but also in other sites (throat, axilla, groin etc).
- Underlying carriage is the issue
- Deprived households more at risk (generally due to overcrowding) and consequently eradication of carriage must be affordable.
- Certain ages are more susceptible due to their close skin to skin societal contact.
- Risk factors
- Close contact due overcrowding or susceptible age. (Who lives in your house? -Genogram may assist).
- Compromised skin integrity (provides portal of entry)-eczema, insect bites, abrasions, devices e.g., PEG.
- Nutritional factors notably iron deficiency. Consider dietary history and growth chart.
- Co-morbidities e.g., diabetes and more uncommonly renal or immune deficiency disease. (self and others).
- Differential diagnosis
- Hidradenitis suppurativa see dermnet for in depth information.
- Inflammatory skin diseases notably eczema and psoriasis.
- Chronic granulomatous disease
- Persistent/resistant/recurrent candida (thrush)
- Herpes zoster (Shingles)
- Other definitions
- Clinical Treatment Failure is defined as new lesion(s) after full treatment completed.
- Partial Treatment Failure- history or diary indicates some improvement consider repeating last treatment regimen again before preceding to next step.
- Recurrence
Investigation Summary
- Regarding swabs
- 1st pass swabs: Nasal swab index case or if >1 family member affected nasal swab entire household.
- 2nd pass swabs: Reswab nose, throat and groin of index case and nasal swabs of whole household even if no-one else affected.
- 3rd pass swabs: Swab nose, throat, and groin of all treatment failures in household.
- If nasal swabs negative and clinical scenario convincing: consider other sites eg throat, flexures.
- Treat the clinical scenario not the swabs.
- Consider and investigate as necessary for:
- Co-morbidities e.g., diabetes and more uncommonly renal or immune deficiency disease.
- Nutritional factors notably iron deficiency in children.
- Regarding swabs