Hostname: page-component-78c5997874-g7gxr Total loading time: 0 Render date: 2024-11-16T19:20:21.918Z Has data issue: false hasContentIssue false
  • English
  • Français

The Effect of Total Household Decolonization on Clearance of Colonization With Methicillin-Resistant Staphylococcus aureus

Published online by Cambridge University Press:  28 July 2016

Valerie C. Cluzet ,
Jeffrey S. Gerber ,
Joshua P. Metlay ,
Irving Nachamkin ,
Theoklis E. Zaoutis ,
Meghan F. Davis ,
Kathleen G. Julian ,
Darren R. Linkin ,
Susan E. Coffin  and
David J. Margolis
...Show all authors
Valerie C. Cluzet*
Affiliation:
Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Jeffrey S. Gerber
Affiliation:
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Joshua P. Metlay
Affiliation:
Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
Irving Nachamkin
Affiliation:
Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Theoklis E. Zaoutis
Affiliation:
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Meghan F. Davis
Affiliation:
Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
Kathleen G. Julian
Affiliation:
Division of Infectious Diseases, Penn State Hershey Medical Center, Hershey, Pennsylvania
Darren R. Linkin
Affiliation:
Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Susan E. Coffin
Affiliation:
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
David J. Margolis
Affiliation:
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Judd E. Hollander
Affiliation:
Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
Warren B. Bilker
Affiliation:
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Xiaoyan Han
Affiliation:
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Rakesh D. Mistry
Affiliation:
Section of Emergency Medicine, Children’s Hospital Colorado, Aurora, Colorado
Laurence J. Gavin
Affiliation:
Department of Emergency Medicine, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania
Pam Tolomeo
Affiliation:
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Jacqueleen A. Wise
Affiliation:
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Mary K. Wheeler
Affiliation:
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Baofeng Hu
Affiliation:
Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Neil O. Fishman
Affiliation:
Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
David Royer
Affiliation:
Department of Biology, Lincoln University, Lincoln University, Pennsylvania
Ebbing Lautenbach
Affiliation:
Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
*
Address correspondence to Valerie Cluzet, MD, Hospital of the University of Pennsylvania, Division of Infectious Diseases, 3400 Spruce St, 3rd Fl, Silverstein Bldg, Ste E, Philadelphia, PA 19104 (valeriec@mail.med.upenn.edu).
Get access Rights & Permissions [Opens in a new window]

Abstract

OBJECTIVE

To determine the impact of total household decolonization with intranasal mupirocin and chlorhexidine gluconate body wash on recurrent methicillin-resistant Staphylococcus aureus (MRSA) infection among subjects with MRSA skin and soft-tissue infection.

DESIGN

Three-arm nonmasked randomized controlled trial.

SETTING

Five academic medical centers in Southeastern Pennsylvania.

PARTICIPANTS

Adults and children presenting to ambulatory care settings with community-onset MRSA skin and soft-tissue infection (ie, index cases) and their household members.

INTERVENTION

Enrolled households were randomized to 1 of 3 intervention groups: (1) education on routine hygiene measures, (2) education plus decolonization without reminders (intranasal mupirocin ointment twice daily for 7 days and chlorhexidine gluconate on the first and last day), or (3) education plus decolonization with reminders, where subjects received daily telephone call or text message reminders.

MAIN OUTCOME MEASURES

Owing to small numbers of recurrent infections, this analysis focused on time to clearance of colonization in the index case.

RESULTS

Of 223 households, 73 were randomized to education-only, 76 to decolonization without reminders, 74 to decolonization with reminders. There was no significant difference in time to clearance of colonization between the education-only and decolonization groups (log-rank P=.768). In secondary analyses, compliance with decolonization was associated with decreased time to clearance (P=.018).

CONCLUSIONS

Total household decolonization did not result in decreased time to clearance of MRSA colonization among adults and children with MRSA skin and soft-tissue infection. However, subjects who were compliant with the protocol had more rapid clearance

Trial registration. ClinicalTrials.gov identifier: NCT00966446

Infect Control Hosp Epidemiol 2016;1–8

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 10 , October 2016 , pp. 1226 - 1233
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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.)

Footnotes

Presented in part: IDWeek 2014 Scientific Conference; Philadelphia, Pennsylvania; October 11, 2014 (Abstract 1336).

References

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;168:1585–1591.Google Scholar
2. Moran, GJ, Krishnadasan, A, Gorwitz, RJ, et al. Methicillin-resistant S. aureus infections among patients in the emergency department. N Engl J Med 2006;355:666–674.Google Scholar
3. Kaplan, SL, Hulten, KG, Gonzalez, BE, et al. Three-year surveillance of community-acquired Staphylococcus aureus infections in children. Clin Infect Dis 2005;40:1785–1791.Google Scholar
4. Kluytmans, J, van Belkum, A, Verbrugh, H. Nasal carriage of Staphylococcus aureus: epidemiology, underlying mechanisms, and associated risks. Clin Microbiol Rev 1997;10:505–520.Google Scholar
5. Mertz, D, Frei, R, Jaussi, B, et al. Throat swabs are necessary to reliably detect carriers of Staphylococcus aureus . Clin Infect Dis 2007;45:475–477.Google Scholar
6. Eveillard, M, de Lassence, A, Lancien, E, Barnaud, G, Ricard, JD, Joly-Guillou, ML. Evaluation of a strategy of screening multiple anatomical sites for methicillin-resistant Staphylococcus aureus at admission to a teaching hospital. Infect Control Hosp Epidemiol 2006;27:181–184.Google Scholar
7. Peters, PJ, Brooks, JT, Limbago, B, et al. Methicillin-resistant Staphylococcus aureus colonization in HIV-infected outpatients is common and detection is enhanced by groin culture. Epidemiol Infect 2011;139:998–1008.CrossRefGoogle ScholarPubMed
8. Shurland, SM, Stine, OC, Venezia, RA, et al. Colonization sites of USA300 methicillin-resistant Staphylococcus aureus in residents of extended care facilities. Infect Control Hosp Epidemiol 2009;30:313–318.CrossRefGoogle ScholarPubMed
9. Huang, SS, Platt, R. Risk of methicillin-resistant Staphylococcus aureus infection after previous infection or colonization. Clin Infect Dis 2003;36:281–285.Google Scholar
10. Marschall, J, Muhlemann, K. Duration of methicillin-resistant Staphylococcus aureus carriage, according to risk factors for acquisition. Infect Control Hosp Epidemiol 2006;27:1206–1212.Google Scholar
11. 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;39:971–979.Google Scholar
12. Coello, R, Glynn, JR, Gaspar, C, Picazo, JJ, Fereres, J. Risk factors for developing clinical infection with methicillin-resistant Staphylococcus aureus (MRSA) amongst hospital patients initially only colonized with MRSA. J Hosp Infect 1997;37:39–46.CrossRefGoogle ScholarPubMed
13. Davis, KA, Stewart, JJ, Crouch, HK, Florez, CE, Hospenthal, DR. Methicillin-resistant Staphylococcus aureus (MRSA) nares colonization at hospital admission and its effect on subsequent MRSA infection. Clin Infect Dis 2004;39:776–782.Google Scholar
14. 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;44:483–492.Google Scholar
15. Chen, AE, Cantey, JB, Carroll, KC, Ross, T, Speser, S, Siberry, GK. Discordance between Staphylococcus aureus nasal colonization and skin infections in children. Pediatr Infect Dis J 2009;28:244–246.Google Scholar
16. Fritz, SA, Hogan, PG, Hayek, G, et al. Household versus individual approaches to eradication of community-associated Staphylococcus aureus in children: a randomized trial. Clin Infect Dis 2012;54:743–751.Google Scholar
17. Doebbeling, BN, Breneman, DL, Neu, HC, et al. Elimination of Staphylococcus aureus nasal carriage in health care workers: analysis of six clinical trials with calcium mupirocin ointment. The Mupirocin Collaborative Study Group. Clin Infect Dis 1993;17:466–474.CrossRefGoogle ScholarPubMed
18. Mascitti, KB, Gerber, JS, Zaoutis, TE, Barton, TD, Lautenbach, E. Preferred treatment and prevention strategies for recurrent community-associated methicillin-resistant Staphylococcus aureus skin and soft-tissue infections: a survey of adult and pediatric providers. Am J Infect Control 2010;38:324–328.Google Scholar
19. 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;51:3591–3598.Google Scholar
20. Fritz, SA, Hogan, PG, Hayek, G, et al. Staphylococcus aureus colonization in children with community-associated Staphylococcus aureus skin infections and their household contacts. Arch Pediatr Adolesc Med 2012;166:551–557.Google Scholar
21. Mollema, FP, Richardus, JH, Behrendt, M, et al. Transmission of methicillin-resistant Staphylococcus aureus to household contacts. J Clin Microbiol 2010;48:202–207.Google Scholar
22. Rodriguez, M, Hogan, PG, Krauss, M, Warren, DK, Fritz, SA. Measurement and impact of colonization pressure in households. J Pediatr Infect Dis Soc 2013;2:147–154.Google Scholar
23. Larsson, AK, Gustafsson, E, Nilsson, AC, Odenholt, I, Ringberg, H, Melander, E. Duration of methicillin-resistant Staphylococcus aureus colonization after diagnosis: a four-year experience from southern Sweden. Scand J Infect Dis 2011;43:456–462.Google Scholar
24. Cluzet, VC, Gerber, JS, Nachamkin, I, et al. Duration of colonization and determinants of earlier clearance of colonization with methicillin-resistant Staphylococcus aureus . Clin Infect Dis 2015;60:1489–1496.CrossRefGoogle ScholarPubMed
25. Calfee, DP, Durbin, LJ, Germanson, TP, Toney, DM, Smith, EB, Farr, BM. Spread of methicillin-resistant Staphylococcus aureus (MRSA) among household contacts of individuals with nosocomially acquired MRSA. Infect Control Hosp Epidemiol 2003;24:422–426.Google Scholar
26. Dietrich, DW, Auld, DB, Mermel, LA. Community-acquired methicillin-resistant Staphylococcus aureus in southern New England children. Pediatrics 2004;113:e347–e352.CrossRefGoogle ScholarPubMed
27. Moran, GJ, Amii, RN, Abrahamian, FM, Talan, DA. Methicillin-resistant Staphylococcus aureus in community-acquired skin infections. Emerg Infect Dis 2005;11:928–930.CrossRefGoogle ScholarPubMed
28. Cluzet, VC, Gerber, JS, Nachamkin, I, et al. Risk factors for recurrent colonization with methicillin-resistant Staphylococcus aureus in community-dwelling adults and children. Infect Control Hosp Epidemiol 2015:1–8.Google ScholarPubMed
29. Zeller, JL, Golub, RM. JAMA patient page. MRSA infections. JAMA 2011;306:1818.Google Scholar
30. Bishop, EJ, Grabsch, EA, Ballard, SA, et al. Concurrent analysis of nose and groin swab specimens by the IDI-MRSA PCR assay is comparable to analysis by individual-specimen PCR and routine culture assays for detection of colonization by methicillin-resistant Staphylococcus aureus . J Clin Microbiol 2006;44:2904–2908.Google Scholar
31. Grmek-Kosnik, I, Ihan, A, Dermota, U, Rems, M, Kosnik, M, Jorn Kolmos, H. Evaluation of separate vs pooled swab cultures, different media, broth enrichment and anatomical sites of screening for the detection of methicillin-resistant Staphylococcus aureus from clinical specimens. J Hosp Infect 2005;61:155–161.Google Scholar
32. 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;30:380–382.Google Scholar
33. Han, Z, Lautenbach, E, Fishman, NO, Nachamkin, I. Evaluation of mannitol salt agar, CHROMagar™ Staph aureus and CHROMagar™ MRSA for detection of methicillin-resistant Staphylococcus aureus from nasal swab specimens. J Med Microbiol 2007;56:43–46.CrossRefGoogle ScholarPubMed
34. Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Susceptibility Testing: 18th Informational Supplement. CLSI document. Wayne, PA: CLSI; 2008:M100-S18.Google Scholar
35. Kaplan, SL, Forbes, A, Hammerman, WA, et al. Randomized trial of “bleach baths” plus routine hygienic measures vs. routine hygienic measures alone for prevention of recurrent infections. Clin Infect Dis 2014;58:679–682.Google Scholar
36. Scanvic, A, Denic, L, Gaillon, S, Giry, P, Andremont, A, Lucet, JC. Duration of colonization by methicillin-resistant Staphylococcus aureus after hospital discharge and risk factors for prolonged carriage. Clin Infect Dis 2001;32:1393–1398.Google Scholar
37. Robicsek, A, Beaumont, JL, Peterson, LR. Duration of colonization with methicillin-resistant Staphylococcus aureus . Clin Infect Dis 2009;48:910–913.Google Scholar
38. Fritz, SA, Hogan, PG, Singh, LN, et al. Contamination of environmental surfaces with Staphylococcus aureus in households with children infected with methicillin-resistant S aureus . JAMA Pediatr 2014;168:1030–1038.Google Scholar
39. Bramble, M, Morris, D, Tolomeo, P, Lautenbach, E. Potential role of pet animals in household transmission of methicillin-resistant Staphylococcus aureus: a narrative review. Vector Borne Zoonotic Dis 2011;11:617–620.Google Scholar
40. Davis, MF, Iverson, SA, Baron, P, et al. Household transmission of meticillin-resistant Staphylococcus aureus and other staphylococci. Lancet Infect Dis 2012;12:703–716.Google Scholar
Supplementary material: PDF

Cluzet supplementary material S1

Cluzet supplementary material

Download Cluzet supplementary material S1(PDF)
PDF 95.5 KB
Supplementary material: File

Cluzet supplementary material S2

Supplementary Table

Download Cluzet supplementary material S2(File)
File 86.4 KB
Supplementary material: Image

Cluzet supplementary material S3

Supplementary Figure

Download Cluzet supplementary material S3(Image)
Image 1.6 MB
Supplementary material: Image

Cluzet supplementary material S4

Supplementary Figure

Download Cluzet supplementary material S4(Image)
Image 1.6 MB
Supplementary material: Image

Cluzet supplementary material S5

Supplementary Figure

Download Cluzet supplementary material S5(Image)
Image 1.6 MB