Skip to main content Accessibility help
×
Home
Hostname: page-component-cf9d5c678-cnwzk Total loading time: 0.277 Render date: 2021-08-02T22:56:59.940Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": true, "newCiteModal": false, "newCitedByModal": true, "newEcommerce": true, "newUsageEvents": true }

Effectiveness of Measures to Eradicate Staphylococcus aureus Carriage in Patients with Community-Associated Skin and Soft-Tissue Infections: A Randomized Trial

Published online by Cambridge University Press:  02 January 2015

Stephanie A. Fritz
Affiliation:
Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
Bernard C. Camins
Affiliation:
Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
Kimberly A. Eisenstein
Affiliation:
Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
Joseph M. Fritz
Affiliation:
Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
Emma K. Epplin
Affiliation:
Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
Carey-Ann Burnham
Affiliation:
Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
Jonathan Dukes
Affiliation:
Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
Gregory A. Storch
Affiliation:
Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
Corresponding
E-mail address:

Abstract

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.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Hersh, AL, Chambers, HF, Maselli, JH, Gonzales, R. National trends in ambulatory visits and antibiotic prescribing for skin and soft-tissue infections. Arch Intern Med 2008;168:15851591.CrossRefGoogle ScholarPubMed
2.Orscheln, RC, Hunstad, DA, Fritz, SA, et al.Contribution of genetically restricted, methicillin-susceptible strains to the ongoing epidemic of community-acquired Staphylococcus aureus infections. Clin Infect Dis 2009;49:536542.CrossRefGoogle ScholarPubMed
3.Kaplan, SL. Community-acquired methicillin-resistant Staphylococcus aureus infections in children. Semin Pediatr Infect Dis 2006;17:113119.CrossRefGoogle ScholarPubMed
4.Toshkova, K, Annemulier, C, Akineden, O, Lammler, C. The significance of nasal carriage of Staphylococcus aureus as risk factor for human skin infections. FEMS Microbiol Lett 2001;202:1724.CrossRefGoogle Scholar
5.Ellis, MW, Hospenthal, DR, Dooley, DP, Gray, PJ, Murray, CK. Natural history of community-acquired methicillin-resistant Staphylococcus aureus colonization and infection in soldiers. Clin Infect Dis 2004;39:971979.CrossRefGoogle ScholarPubMed
6.Fritz, SA, Epplin, EK, Garbutt, J, Storch, GA. Skin infection in children colonized with community-associated methicillin-resistant Staphylococcus aureus. J Infect 2009;59:394401.CrossRefGoogle ScholarPubMed
7.Laupland, KB, Conly, JM. Treatment of Staphylococcus aureus colonization and prophylaxis for infection with topical intranasal mupirocin: an evidence-based review. Clin Infect Dis 2003;37:933938.CrossRefGoogle Scholar
8.Perl, TM, Cullen, JJ, Wenzel, RP, et al.Intranasal mupirocin to prevent postoperative Staphylococcus aureus infections. N Engl J Med 2002;346:18711877.CrossRefGoogle ScholarPubMed
9.Bode, LG, Kluytmans, JA, Wertheim, HF, et al.Preventing surgical-site infections in nasal carriers of Staphylococcus aureus. N Engl J Med 2010;362:917.CrossRefGoogle ScholarPubMed
10.Wendt, C, Schinke, S, Wurttemberger, M, Oberdorfer, K, Bock-Hensley, O, von Baum, H. Value of whole-body washing with Chlorhexidine for the eradication of methicillin-resistant Staphylococcus aureus-, a randomized, placebo-controlled, double-blind clinical trial. Infect Control Hosp Epidemiol 2007;28:10361043.CrossRefGoogle ScholarPubMed
11.Simor, AE, Phillips, E, McGeer, A, et al.Randomized controlled trial of Chlorhexidine gluconate for washing, intranasal mupirocin, and rifampin and doxycycline versus no treatment for the eradication of methicillin-resistant Staphylococcus aureus colonization. Clin Infect Dis 2007;44:178185.CrossRefGoogle ScholarPubMed
12.Kaplan, SL, Hulten, KG, Gonzalez, BE, et al.Three-year surveillance of community-acquired Staphylococcus aureus infections in children. Clin Infect Dis 2005;40:17851791.CrossRefGoogle ScholarPubMed
13.McCaskill, ML, Mason, EO Jr, Kaplan, SL, Hammerman, W, Lam-berth, LB, Hulten, KG. Increase of the USA300 clone among community-acquired methicillin-susceptible Staphylococcus aureus causing invasive infections. Pediatr Infect Dis J 2007;26:11221127.CrossRefGoogle ScholarPubMed
14.Diep, BA, Gill, SR, Chang, RF, et al.Complete genome sequence of USA300, an epidemic clone of community-acquired methicillin-resistant Staphylococcus aureus. Lancet 2006;367:731739.CrossRefGoogle Scholar
15.Goering, RV, McDougal, LK, Fosheim, GE, Bonnstetter, KK, Wolter, DJ, Tenover, FC. Epidemiologic distribution of the arginine catabolic mobile element among selected methicillin-resistant and methicillin-susceptible Staphylococcus aureus isolates. J Clin Microbiol 2007;45:19811984.CrossRefGoogle ScholarPubMed
16.DeLeo, FR, Diep, BA, Otto, M. Host defense and pathogenesis in Staphylococcus aureus infections. Infect Dis Clin North Am 2009;23:1734.CrossRefGoogle ScholarPubMed
17.Creech, CB, Beekmann, SE, Chen, Y, Polgreen, PM. Variability among pediatric infectious diseases specialists in the treatment and prevention of methicillin-resistant Staphylococcus aureus skin and soft tissue infections. Pediatr Infect Dis J 2008;27:270272.CrossRefGoogle ScholarPubMed
18.Liu, C, Bayer, A, Cosgrove, SE, et al.Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children: executive summary. Clin Infect Dis 2011;52:285292.CrossRefGoogle Scholar
19.Gorwitz, RJ, Jernigan, DB, Powers, JH, Jernigan, JA; Participants in the CDC-Convened Experts' Meeting on Management of MRSA in the Community. Strategies for clinical management of MRSA in the community: summary of an experts' meeting convened by the Centers for Disease Control and Prevention. Atlanta: Center for Disease Control and Prevention, 2006. http://www.cdc.gov/ncidod/dhqp/pdf/ar/CAMRSA_ExpMtgStrategies.pdf. Accessed January 2, 2011.Google Scholar
20.Fritz, SA, Krauss, MJ, Epplin, EK, et al.The natural history of contemporary Staphylococcus aureus nasal colonization in community children. Pediatr Infect Dis J 2011;30:349351.CrossRefGoogle ScholarPubMed
21.Lautenbach, E, Nachamkin, I, Hu, B, et al.Surveillance cultures for detection of methicillin-resistant Staphylococcus aureus: diagnostic yield of anatomic sites and comparison of provider-and patient-collected samples. Infect Control Hosp Epidemiol 2009;30:380382.CrossRefGoogle Scholar
22.Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Susceptibility Testing; 16th Informational Supplement. Wayne, PA: CLSI, 2006.Google Scholar
23.Fritz, SA, Garbutt, J, Elward, A, Shannon, W, Storch, GA. Prevalence of and risk factors for community-acquired methicillin-resistant and methicillin-sensitive Staphylococcus aureus colonization in children seen in a practice-based research network. Pediatrics 2008;121:10901098.CrossRefGoogle Scholar
24.Hogue, JS, Buttke, P, Braun, LE, Fairchok, MP. Mupirocin resistance related to increasing mupirocin use in clinical isolates of methicillin-resistant Staphylococcus aureus in a pediatric population. J Clin Microbiol 2010;48:25992600.CrossRefGoogle Scholar
25.Huang, JT, Abrams, M, Tlougan, B, Rademaker, A, Palier, AS. Treatment of Staphylococcus aureus colonization in atopic dermatitis decreases disease severity. Pediatrics 2009;123:e808e814.CrossRefGoogle Scholar
26.Heggers, JP, Sazy, JA, Stenberg, BD, et al.Bactericidal and wound-healing properties of sodium hypochlorite solutions: the 1991 Lindberg Award. J Burn Care Rehabil 1991;12:420424.CrossRefGoogle Scholar
27.Fisher, RG, Chain, RL, Hair, PS, Cunnion, KM. Hypochlorite killing of community-associated methicillin-resistant Staphylococcus aureus. Pediatr Infect Dis J 2008;27:934935.CrossRefGoogle ScholarPubMed
28.Palier, AS, Mancini, AJ. Eczematous eruptions in childhood. In: Palier, AS, Mancini, AJ, eds. Hurwitz Clinical Pediatric Dermatology. 3rd ed. Philadelphia: Elsevier, 2006.Google Scholar
29.Fritz, SA, Hayek, G, Mitchell, K, Garbutt, J, Fraser, VJ. Community-associated Staphylococcus aureus colonization in children with S. aureus skin infections and their household members. In: Program and abstracts of the Infectious Diseases Society of America 47th Annual Meeting; October 29-November 1, 2009; Philadelphia. Abstract 802.Google Scholar
30.Bleasdale, SC, Trick, WE, Gonzalez, IM, Lyles, RD, Hayden, MK, Weinstein, RA. Effectiveness of Chlorhexidine bathing to reduce catheter-associated bloodstream infections in medical intensive care unit patients. Arch Intern Med 2007;167:20732079.CrossRefGoogle ScholarPubMed
31.Popovich, KJ, Hota, B, Hayes, R, Weinstein, RA, Hayden, MK. Effectiveness of routine patient cleansing with Chlorhexidine gluconate for infection prevention in the medical intensive care unit. Infect Control Hosp Epidemiol 2009;30:959963.CrossRefGoogle ScholarPubMed
32.Ammerlaan, HS, Kluytmans, JA, Wertheim, HF, Nouwen, JL, Bon-ten, MJ. Eradication of methicillin-resistant Staphylococcus aureus carriage: a systematic review. Clin Infect Dis 2009;48:922930.CrossRefGoogle ScholarPubMed
33.Loeb, M, Main, C, Walker-Dilks, C, Eady, A. Antimicrobial drugs for treating methicillin-resistant Staphylococcus aureus colonization. Cochrane Database Syst Rev 2003:CD003340.Google ScholarPubMed
34.Yang, ES, Tan, J, Eells, S, Rieg, G, Tagudar, G, Miller, LG. Body site colonization in patients with community-associated methicillin-resistant Staphylococcus aureus and other types of S. aureus skin infections. Clin Microbiol Infect 2010;16:425431.CrossRefGoogle ScholarPubMed
35.Buehlmann, M, Frei, R, Fenner, L, Dangel, M, Fluckiger, U, Widmer, ARHighly effective regimen for decolonization of methicillin-resistant Staphylococcus aureus carriers. Infect Control Hosp Epidemiol. 2008;29:510516.CrossRefGoogle ScholarPubMed
36.Miller, MA, Dascal, A, Portnoy, J, Mendelson, J. Development of mupirocin resistance among methicillin-resistant Staphylococcus aureus after widespread use of nasal mupirocin ointment. Infect Control Hosp Epidemiol 1996;17:811813.CrossRefGoogle ScholarPubMed
37.Upton, A, Lang, S, Heffernan, H. Mupirocin and Staphylococcus aureus: a recent paradigm of emerging antibiotic resistance. J Antimicrob Chemother 2003;51:613617.CrossRefGoogle ScholarPubMed
38.Miller, LG, Quan, C, Shay, A, et al.A prospective investigation of outcomes after hospital discharge for endemic, community-acquired methicillin-resistant and -susceptible Staphylococcus aureus skin infection. Clin Infect Dis 2007;44:483492.CrossRefGoogle ScholarPubMed
39.Duong, M, Markwell, S, Peter, J, Barenkamp, S. Randomized, controlled trial of antibiotics in the management of community-acquired skin abscesses in the pediatric patient. Ann EmergMed 2010;55:401407.CrossRefGoogle ScholarPubMed
40.Ellis, MW, Griffith, ME, Dooley, DP, et al.Targeted intranasal mupirocin to prevent colonization and infection by community-associated methicillin-resistant Staphylococcus aureus strains in soldiers: a cluster randomized controlled trial. Antimicrob Agents Chemother 2007;51:35913598.CrossRefGoogle ScholarPubMed
41.Jones, TF, Creech, CB, Erwin, P, Baird, SG, Woron, AM, Schaffner, W. Family outbreaks of invasive community-associated methicillin-resistant Staphylococcus aureus infection. Clin Infect Dis 2006;42:e7678.CrossRefGoogle ScholarPubMed
90
Cited by

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Effectiveness of Measures to Eradicate Staphylococcus aureus Carriage in Patients with Community-Associated Skin and Soft-Tissue Infections: A Randomized Trial
Available formats
×

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

Effectiveness of Measures to Eradicate Staphylococcus aureus Carriage in Patients with Community-Associated Skin and Soft-Tissue Infections: A Randomized Trial
Available formats
×

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

Effectiveness of Measures to Eradicate Staphylococcus aureus Carriage in Patients with Community-Associated Skin and Soft-Tissue Infections: A Randomized Trial
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *