Short summary

Methicillin-resistant Staphylococcus aureus (MRSA) is a strain of Staph, which has become resistant to methicillin and other similar antibiotics. Unfortunately, MRSA infections can be serious, even fatal and the number is increasing. Furthermore, patients expire stigmatisation and poor mental health. According to Danish guidelines, MRSA care programs can be managed by a general practitioner (GP) or by a MRSA-unit. However, it might be difficult for GPs to develop routines due to the complexity of the MRSA care program. Therefore, this study aims to evaluate and rethink MRSA-programs in the outpatient sector. This will include: • Measure the current effectiveness of the MRSA treatment, in a retrospective cohort study • Evaluate the experience of having MRSA among MRSA-diagnosed patients, done by self-reported questionnaire • Develop and evaluate a MRSA video consultation, which combines knowledge between patients, MRSA-units, and GP, by participatory design and a randomised control trial.

Rationale

In the past decades, Methicillin-resistant Staphylococcus aureus (MRSA) has become one of the most important multidrug-resistant pathogens worldwide, causing significant morbidity and increased healthcare costs. In 2007, 661 new cases were reported in Denmark, and in 2019, this number had increased to 3657 new cases. To prevent the spread of MRSA many countries recommend MRSA-treatment and follow-up programs and strict hygiene efforts to prevent transmission. A downside is stigmatisation and poor mental health among MRSA-diagnosed especially when the management of MRSA-diagnosed is handled by the outpatient sector. Several studies also report low rates for successful treatment and compliance towards the follow-up program. The overall study aim is to evaluate and rethink MRSA-programs in the outpatient sector in the Region of Southern Denmark. The study is divided into three substudies with specific objectives: 1: Describe the effectiveness of decolonisation treatment in a retrospective cohort study from 2014-2018 with 3,000 MRSA-diagnosed individuals. 2: Describe illness perception, patient satisfaction, stigmatisation, and mental health in a cohort of 300 patients, 1, 6, and 12 months after MRSA diagnosis. Furthermore, to identify vulnerable patients categories, e.g., livestock MRSA, patients suffering from a mental or somatic disease, or families with young children. 3: Develop a new organisational collaboratory model (3a) to managemant MRSA-programs. Evaluate the model in which a MRSA-specialist participates in the consultation between the GP and the patient through video conference (3b). 3a: To develop a useful and generally accepted collaboratory model by involving GP´s, patients, and MRSA-specialist (participatory design), the process, and a pilot testing period. 3b: To study the impact on treatment and illness perception, patient satisfaction, stigmatisation, and mental health among 80 MRSA-diagnosed patients using the collaboratory model (randomised controlled trial).

Description of the cohort

Cohort: MRSA diagnosed, in the Region of Southern Denmark in which 700-800 yearly new cases are identified. Study 1: Treatment indication (approximately 60% of new cases) Study 2 and 3: : Age ≤ 18 Ability to understand and speak Danish Mental ability to cooperate Written informed consent given

Data and biological material

Data Study 1: Register data: Period and type of decolonisation treatment Samples cultured for MRSA Comorbidity Socioeconomic factors, e.g. educational level Study 2: Self-reported questionnaire: Stigma Mental health Ilness perception Patient satisfaction Study 3b Register data: Period and type of decolonisation treatment Samples cultured for MRSA Comorbidity Socioeconomic factors, e.g. educational level Self-reported questionnaire: Stigma Mental health Ilness perception Patient satisfaction General practitioner and patient user satisfaction with MRSA video consultation

Collaborating researchers and departments

Infection Control Unit, Odense University Hospital

• Infection Control Unit, The Hospital of South West Jutland
• Infection Control Unit, hospital of Southern Jutland