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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).
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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 

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Footnotes

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

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