Tonsillectomy for persistent MRSA carriage in the throat-Description of three cases

Abstract

In several countries, including the Netherlands, a search and destroy policy is part of the standard of care. Due to this policy and the restrictive use of antibiotics, the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in the Netherlands - carrier state and infections - is among the lowest in the world. In the Netherlands, healthcare workers who are MRSA carriers are not allowed to perform work involving direct patient care. This means that treatment failure can have major implications for their working career. Despite repeated treatments according to guidelines, the eradication of MRSA fails in a minority of cases. It appears that performing a tonsillectomy can be part of the solution to this problem. As yet, tonsillectomy is not recommended as supplementary treatment for persistent MRSA carriage in the throat. There are a few expert opinions suggesting that tonsillectomy could possibly be helpful in decolonization. This article reports three recent cases in which MRSA eradication was successful only after tonsillectomy. It is believed that if eradication is necessary, tonsillectomy, if applicable, should be considered.

Keywords: Carrier; MRSA; Staphylococcus aureus; Tonsillectomy.