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

  • Stephanie A. Fritz (a1), Bernard C. Camins (a2), Kimberly A. Eisenstein (a1) (a2), Joseph M. Fritz (a2), Emma K. Epplin (a1) (a2), Carey-Ann Burnham (a1) (a3), Jonathan Dukes (a2) and Gregory A. Storch (a1) (a2)...
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.

Copyright
Corresponding author
660 South Euclid Avenue, Campus Box 8116, St. Louis, MO 63110 (fritz_s@kids.wustl.edu)
References
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