MMRSA Guide
Microscopic illustration of MRSA (Staphylococcus aureus) bacteria
Reference · Prevention · Recurrence

Why MRSA keeps coming back — and how to stop it

Most people who keep getting MRSA aren't catching it fresh each time. They're carrying it — in the nose, the groin, the axillae, or on a close contact — and the reservoir refills the skin every few months.

Written by David Roberts, editor · Updated

Checked against current CDC and IDSA guidance. Not medically reviewed. How we source this

The reservoir problem

Staphylococcus aureus lives happily on human skin and in the front of the nose. Around 20–30% of the healthy population carries it persistently. MRSA carriage is less common but behaves the same way: antibiotics clear the visible abscess, the reservoir sits untouched, and a new abscess appears weeks or months later, often at a different site. Two or more infections in a year is the usual threshold for calling MRSA recurrent — and for going after the reservoir directly.

Decolonisation — the standard regimen

The regimen used across the NHS, the CDC and most European guidance is built around Bactroban (mupirocin) 2% nasal ointment:

  • Mupirocin 2% nasal ointment — a pea-sized amount to each nostril, twice daily, for 5 days.
  • Chlorhexidine 4% body wash — used daily as a shower gel for 5–10 days, including the hair on day 1 and day 5.
  • Toothbrush and razor changed at the start and end of the course.
  • Bedding, towels and clothing laundered hot on day 1 and day 5.

For stubborn cases where topical treatment alone fails, some specialists add a 7–10 day course of oral rifampin plus doxycycline, but this should only be used under supervision because rifampin monotherapy rapidly selects for resistance.

Treat the household, not just the patient

One of the strongest predictors of recurrence is a colonised household contact. Randomised trials have shown that treating the whole household at once — everyone doing 5 days of mupirocin and chlorhexidine simultaneously, plus a hot laundry day — cuts one-year recurrence rates by roughly half compared with treating the index patient alone.

Risk factors that keep MRSA coming back

  • Persistent nasal, throat or groin colonisation.
  • A colonised household member, sexual partner or team-mate.
  • Diabetes, eczema, obesity or chronic skin conditions.
  • IV drug use.
  • Recurrent skin trauma from work or sport.
  • Repeated courses of broad-spectrum antibiotics.
  • PVL-positive strains such as USA300.

Related in prevention

Back to the prevention hub, or read about preventing MRSA at home, in hospitals, in sports and during intimacy.

Frequently asked questions

Why does MRSA keep coming back?
Recurrence almost always reflects ongoing colonisation somewhere on the body — most often the nose, but also the throat, groin, axillae and perineum — or a colonised close contact acting as a reservoir. The bacteria are cleared from the visible lesion by antibiotics and drainage, but the reservoir refills the skin and a new abscess appears weeks or months later.
What is MRSA decolonisation?
Decolonisation is a short course of topical antibiotics and antiseptics that reduces the amount of MRSA carried on the skin and in the nose. The standard regimen is mupirocin 2% nasal ointment applied to both nostrils twice daily plus a daily chlorhexidine 4% body wash (including hair on day 1 and day 5) for 5–10 days. Some protocols add oral rifampin plus doxycycline for stubborn cases.
How well does decolonisation work?
For patients with recurrent skin infections, a 5-day course clears carriage in about 70–90% of people at one month. Recolonisation is common over the following year, especially if a household contact is also colonised. Repeat courses and simultaneous treatment of the household improve durability.
Should my whole family be treated?
If you have had two or more MRSA infections in a year, or infections in more than one household member, most clinicians recommend simultaneous decolonisation of all close contacts. Trials have shown this cuts recurrence rates significantly compared with treating the index patient alone.
What are the risk factors for recurrent MRSA?
Nasal colonisation, diabetes, eczema or other skin conditions, obesity, IV drug use, recurrent skin trauma, sharing a household with another carrier, close-contact sports, and prior antibiotic use are all associated with recurrence. USA300 (PVL-positive) infections are particularly prone to recur.
Can I decolonise myself?
Mupirocin nasal ointment is prescription-only in most countries. Chlorhexidine wash is available over the counter. Don't attempt to self-treat recurrent MRSA — get swabs taken, get the sites of colonisation identified, and use a supervised regimen. Random courses of oral antibiotics without cultures drive resistance and rarely fix the problem.

Prevention hub

Overview of MRSA prevention across settings.

Mupirocin (Bactroban)

How the nasal decolonisation antibiotic works.

Chlorhexidine

The antiseptic used for daily bathing, pre-surgical showers and decolonisation.

Is there an MRSA vaccine?

Why no vaccine exists, the trials that failed and what protects you instead.

Is MRSA contagious?

How MRSA spreads, for how long, and how to stop it in each setting.

The decolonisation protocol

The full five-day mupirocin and chlorhexidine regimen, how well it works and its limits are set out on the MRSA decolonisation page.

References
  1. Fritz S.A. et al., Clinical Infectious Diseases. Household versus individual approaches to eradication of community-associated Staphylococcus aureus in children: a randomized trial (2012)
  2. Liu C. et al., IDSA. Clinical practice guidelines for the treatment of MRSA infections — decolonisation for recurrent SSTI (2011)
  3. CDC. MRSA — precautions for those with recurrent infections (2024)
  4. Cochrane Database of Systematic Reviews. Nasal mupirocin for preventing Staphylococcus aureus infections (2020)
  5. Ammerlaan H.S.M. et al., Clinical Infectious Diseases. Eradication of methicillin-resistant Staphylococcus aureus carriage: a systematic review (2009)
  6. Simor A.E. et al., Clinical Infectious Diseases. Randomised trial of chlorhexidine gluconate, intranasal mupirocin, rifampin and doxycycline for MRSA decolonisation (2007)
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