Skip to main content
×
Home
    • Aa
    • Aa

Chlorhexidine Gluconate Reduces Transmission of Methicillin-Resistant Staphylococcus aureus USA300 among Marine Recruits

  • Timothy J. Whitman (a1), Carey D. Schlett (a2), Greg A. Grandits (a3), Eugene V. Millar (a2), Katrin Mende (a2) (a4), Duane R. Hospenthal (a4), Patrick R. Murray (a5) and David R. Tribble (a2)...
Abstract
Background.

Methicillin-resistant Staphylococcus aureus (MRSA) pulsed-field type (PFT) USA300 causes skin and soft tissue infections in military recruits and invasive disease in hospitals. Chlorhexidine gluconate (CHG) is used to reduce MRSA colonization and infection. The impact of CHG on the molecular epidemiology of MRSA is not known.

Objective.

To evaluate the impact of 2% CHG—impregnated cloths on the molecular epidemiology of MRSA colonization.

Design.

Cluster-randomized, double-blind, controlled trial.

Setting.

Marine Officer Candidate School, Quantico, Virginia, in 2007.

Participants.

Military recruits.

Intervention.

Thrice-weekly application of CHG-impregnated or control (Comfort Bath; Sage) cloths over the entire body.

Measurements.

Baseline and serial (every 2 weeks) nasal and/or axillary swab samples were assessed for MRSA colonization. Molecular analysis was performed with pulsed-field gel electrophoresis.

Results.

During training, 77 subjects (4.9%) acquired MRSA, 26 (3.3%) in the CHG group and 51 (6.5%) in the control group (P = .004). When analyzed for PFT, 24 subjects (3.1%) in the control group but only 6 subjects (0.8%) in the CHG group (P = .001) had USA300. Of the 167 colonizing isolates recovered from 77 subjects, 99 were recovered from the control group, including USA300 (40.4%), USA800 (38.4%), USA1000 (12.1%), and USA100 (6.1%), and 68 were recovered from the CHG group, including USA800 (51.5%), USA100 (23.5%), and USA300 (13.2%).

Conclusions.

CHG decreased the transmission of MRSA—more specifically, USA300—among military recruits. In addition, USA300 and USA800 outcompeted other MRSA PFTs at incident colonization. Future studies should evaluate the broad-based use of CHG to decrease transmission of USA300 in hospital settings.

Copyright
Corresponding author
Department of Infectious Diseases, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda MD 20889 (timothy.whitman@med.navy.mil)
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

1. MW Ellis , DR Hospenthal , DP Dooley , PJ Gray , CK Murray . Natural history of community-acquired methicillin-resistant Staphylococcus aureus colonization and infection in soldiers. Clin Infect Dis 2004;39(7): 971979.

2. SK Fridkin , JC Hageman , M Morrison , et al. Methicillin-resistant Staphylococcus aureus disease in three communities. N Engl J Med 2005;352(14): 14361444.

3. GR Kravitz , DJ Dries , ML Peterson , PM Schlievert . Purpura fulminans due to Staphylococcus aureus. Clin Infect Dis 2005;40(7):941947.

6. LK McDougal , CD Steward , GE Killgore , JM Chaitram , SK McAllister , FC Tenover . Pulsed-field gel electrophoresis typing of oxacillin-resistant Staphylococcus aureus isolates from the United States: establishing a national database. J Clin Microbiol 2003;41(11): 51135120.

7. RJ Gorwitz , D Kruszon-Moran , SK McAllister , et al. Changes in the prevalence of nasal colonization with Staphylococcus aureus in the United States, 2001-2004. J Infect Dis 2008;197(9): 12261234.

8. FC Tenover , S McAllister , G Fosheim , et al. Characterization of Staphylococcus aureus isolates from nasal cultures collected from individuals in the United States in 2001 to 2004. J Clin Microbiol 2008;46(9): 28372841.

9. DS Blanc , C Petignat , A Wenger , et al. Changing molecular epidemiology of methicillin-resistant Staphylococcus aureus in a small geographic area over an eight-year period. J Clin Microbiol 2007;45(11):37293736.

10. MD King , BJ Humphrey , YF Wang , EV Kourbatova , SM Ray , HM Blumberg . Emergence of community-acquired methicillin-resistant Staphylococcus aureus USA 300 clone as the predominant cause of skin and soft-tissue infections. Ann Intern Med 2006;144(5): 309317.

11. MW Ellis , ME Griffith , JH Jorgensen , DR Hospenthal , K Mende , JE Patterson . Presence and molecular epidemiology of virulence factors in methicillin-resistant Staphylococcus aureus strains colonizing and infecting soldiers. J Clin Microbiol 2009;47(4):940945.

12. FC Tenover , IA Tickler , RV Goering , BN Kreiswirth , JR Mediavilla , DH Persing . Characterization of nasal and blood culture isolates of methicillin-resistant Staphylococcus aureus from patients in United States hospitals. Antimicrob Agents Chemother 2012;56(3): 13241330.

15. CK Murray , RL Holmes , MW Ellis , et al. Twenty-five year epidemiology of invasive methicillin-resistant Staphylococcus aureus (MRSA) isolates recovered at a burn center. Burns 2009;35(8):11121117.

17. BD Cookson , MC Bolton , JH Platt . Chlorhexidine resistance in methicillin-resistant Staphylococcus aureus or just an elevated MIC? an in vitro and in vivo assessment. Antimicrob Agents Chemother 1991;35(10): 19972002.

18. N Noguchi , M Hase , M Kitta , M Sasatsu , K Deguchi , M Kono . Antiseptic susceptibility and distribution of antiseptic-resistance genes in methicillin-resistant Staphylococcus aureus. FEMS Microbiol Lett 1999;172(2): 247253.

19. PC Austin . A comparison of the statistical power of different methods for the analysis of cluster randomization trials with binary outcomes. Stat Med 2007;26(19): 35503565.

20. KJ Popovich , RA Weinstein , B Hota . Are community-associated methicillin-resistant Staphylococcus aureus (MRSA) strains replacing traditional nosocomial MRSA strains? Clin Infect Dis 2008;46(6): 787794.

21. U Seybold , EV Kourbatova , JG Johnson , et al. Emergence of community-associated methicillin-resistant Staphylococcus aureus USA300 genotype as a major cause of health care-associated blood stream infections. Clin Infect Dis 2006;42(5): 647656.

23. K Sivaraman , N Venkataraman , AM Cole . Staphylococcus aureus nasal carriage and its contributing factors. Future Microbiol 2009;4(8):9991008.

25. A van Belkum , DC Melles , J Nouwen , et al. Co-evolutionary aspects of human colonisation and infection by Staphylococcus aureus. Infect Genet Evol 2009;9(1):3247.

26. GJ Moran , A Krishnadasan , RJ Gorwitz , et al. Methicillin-resistant S. aureus infections among patients in the emergency department. N Engl J Med 2006;355(7): 666674.

28. SC Bleasdale , WE Trick , IM Gonzalez , RD Lyles , MK Hayden , RA Weinstein . Effectiveness of Chlorhexidine bathing to reduce catheter-associated bloodstream infections in medical intensive care unit patients. Arch Intern Med 2007;167(19): 20732079.

30. MW Climo , KA Sepkowitz , G Zuccotti , et al. The effect of daily bathing with Chlorhexidine on the acquisition of methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococ-cus, and healthcare-associated bloodstream infections: results of a quasi-experimental multicenter trial. Crif Care Med 2009;37(6):18581865.

32. JT Wang , WH Sheng , JL Wang , et al. Longitudinal analysis of Chlorhexidine susceptibilities of nosocomial methicillin-resistant Staphylococcus aureus isolates at a teaching hospital in Taiwan. J Antimicrob Chemother 2008;62(3): 514517.

33. N Noguchi , J Suwa , K Narui , et al. Susceptibilities to antiseptic agents and distribution of antiseptic-resistance genes qacA/B and smr of methicillin-resistant Staphylococcus aureus isolated in Asia during 1998 and 1999. J Med Microbiol 2005;54(6): 557565.

34. CB Creech , E Saye , BD McKenna , et al. One-year surveillance of methicillin-resistant Staphylococcus aureus nasal colonization and skin and soft tissue infections in collegiate athletes. Arch Pediatr Adolesc Med 2010;164(7): 615620.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 15 *
Loading metrics...

Abstract views

Total abstract views: 111 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 20th August 2017. This data will be updated every 24 hours.