Document Detail


Effectiveness of measures to eradicate Staphylococcus aureus carriage in patients with community-associated skin and soft-tissue infections: a randomized trial.
MedLine Citation:
PMID:  21828967     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Despite a paucity of evidence, decolonization measures are prescribed for outpatients with recurrent Staphylococcus aureus skin and soft-tissue infection (SSTI).
OBJECTIVE: Compare the effectiveness of 4 regimens for eradicating S. aureus carriage.
DESIGN: Open-label, randomized controlled trial. Colonization status and recurrent SSTI were ascertained at 1 and 4 months.
SETTING: Barnes-Jewish and St. Louis Children's Hospitals, St. Louis, Missouri, 2007-2009.
PARTICIPANTS: Three hundred patients with community-onset SSTI and S. aureus colonization in the nares, axilla, or inguinal folds.
INTERVENTIONS: Participants were randomized to receive no therapeutic intervention (control subjects) or one of three 5-day regimens: 2% mupirocin ointment applied to the nares twice daily, intranasal mupirocin plus daily 4% chlorhexidine body washes, or intranasal mupirocin plus daily dilute bleach water baths.
RESULTS: Among 244 participants with 1-month colonization data, modified intention-to-treat analysis revealed S. aureus eradication in 38% of participants in the education only (control) group, 56% of those in the mupirocin group (P = .03 vs controls), 55% of those in the mupirocin and chlorhexidine group (P = .05), and 63% off those in the mupirocin and bleach group (P = .006). Of 229 participants with 4-month colonization data, eradication rates were 48% in the control group, 56% in the mupirocin only group (P = .40 vs controls), 54% in the mupirocin and chlorhexidine group (P = .51), and 71% in the mupirocin and bleach group (P = .02). At 1 and 4 months, recurrent SSTIs were reported by 20% and 36% of participants, respectively.
CONCLUSIONS: An inexpensive regimen of dilute bleach baths, intranasal mupirocin, and hygiene education effectively eradicated S. aureus over a 4-month period. High rates of recurrent SSTI suggest that factors other than endogenous colonization are important determinants of infection. Trial registration. ClinicalTrials.gov identifier: NCT00513799.
Authors:
Stephanie A Fritz; Bernard C Camins; Kimberly A Eisenstein; Joseph M Fritz; Emma K Epplin; Carey-Ann Burnham; Jonathan Dukes; Gregory A Storch
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Infection control and hospital epidemiology : the official journal of the Society of Hospital Epidemiologists of America     Volume:  32     ISSN:  1559-6834     ISO Abbreviation:  Infect Control Hosp Epidemiol     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-08-10     Completed Date:  2012-01-23     Revised Date:  2013-06-28    
Medline Journal Info:
Nlm Unique ID:  8804099     Medline TA:  Infect Control Hosp Epidemiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  872-80     Citation Subset:  IM; N    
Affiliation:
Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA. fritz_s@kids.wustl.edu
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00513799
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Anti-Bacterial Agents / administration & dosage
Anti-Infective Agents, Local / administration & dosage
Baths
Carrier State / drug therapy*
Child
Child, Preschool
Chlorhexidine / administration & dosage*
Combined Modality Therapy
Community-Acquired Infections / drug therapy
Female
Humans
Infant
Male
Mupirocin / administration & dosage*
Nose / microbiology
Patient Compliance
Patient Education as Topic
Sodium Hypochlorite / administration & dosage*
Soft Tissue Infections / drug therapy*,  therapy
Staphylococcal Skin Infections / drug therapy*,  therapy
Staphylococcus aureus*
Treatment Outcome
Young Adult
Grant Support
ID/Acronym/Agency:
KL2 RR024994/RR/NCRR NIH HHS; KL2RR024994/RR/NCRR NIH HHS; UL1 RR024992/RR/NCRR NIH HHS; UL1-RR024992/RR/NCRR NIH HHS
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents; 0/Anti-Infective Agents, Local; 12650-69-0/Mupirocin; 55-56-1/Chlorhexidine; 7681-52-9/Sodium Hypochlorite
Comments/Corrections
Comment In:
Infect Control Hosp Epidemiol. 2012 Feb;33(2):207-8; author reply 208-10   [PMID:  22227995 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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