Skip to main content Accessibility help
×
Home

Postdischarge Decolonization of Patients Harboring MRSA USA300 Strains: Secondary Analysis of the CLEAR Trial

Published online by Cambridge University Press:  02 November 2020


Gabrielle M. Gussin
Affiliation:
University of California, Irvine
Lauren Heim
Affiliation:
University of California, Irvine
Thomas Tjoa
Affiliation:
Division of Infectious Diseases, University of California Irvine School of Medicine James A. McKinnell, The Lundquist Institute at Harbor's Torrance, CA
Loren Miller
Affiliation:
Harbor-UCLA Medical Center
Daniel L. Gillen
Affiliation:
University of California, Irvine
Mohamad Sater
Affiliation:
Day Zero Diagnostics
Yonatan H. Grad
Affiliation:
Harvard TH Chan School of Public Health
Raveena D. Singh
Affiliation:
University of California, Irvine School of Medicine Susan Huang, University of California Irvine School of Medicine

Abstract

Background: The Changing Lives by Eradicating Antibiotic Resistance (CLEAR) Trial was a trial of 2,121 recently discharged methicillin-resistant Staphylococcus aureus (MRSA) carriers randomized to MRSA education plus a 5-day decolonization regimen repeated twice monthly for the 6 months following discharge versus MRSA education alone. Decolonization resulted in a 30% reduction in MRSA infection and a 17% reduction in all-cause infection (Huang SS et al, NEJM, 2019) in the year following discharge. We pursued an evaluation of USA300 carriers to determine whether the decolonization benefit differed for this strain type. Methods: A secondary analysis of the CLEAR randomized controlled trial (RCT) was performed, limiting the cohort to participants known to harbor USA300 at or within 30 days of enrollment and who attended all follow-up visits in the year following discharge. Within this subset, we conducted a time-to-event analysis using unadjusted and adjusted Cox proportional-hazard models. Variables in adjusted analyses included demographic data, insurance type, presence of coexisting conditions or medical devices at enrollment, hospitalization or residence in a nursing home in the year before enrollment, receipt of anti-MRSA antibiotics, protocol adherence, and randomization strata. Results: USA300 was identified in 420 of the 783 participants who attended all visits and had strains genetically tested. MRSA infections occurred in 27 of 207 education group participants (0.149 per person year) and in 19 of 213 decolonization group participants (0.099 per-person year). Point estimates from the unadjusted hazard ratios of infection reduction were similar (0.59; 95% CI, 0.32–1.09) to the full trial population (0.61; 95% CI, 0.44–0.85), suggesting nondifferential benefit for the USA300 strain type. Adjusted models were highly similar. Conclusions: The reduction in MRSA infection associated with postdischarge decolonization in the subgroup of participants who harbored the USA300 strain-type was consistent with overall trial findings. Although the original trial was not powered for the evaluation of a USA300 subset, this RCT provides a valuable design for assessing the magnitude of strain-specific responsiveness to decolonization during a time when national rates of MRSA invasive disease have plateaued and USA300 is responsible for an increasing proportion of infections. These data suggest that postdischarge decolonization should be similarly effective in carriers of either USA300 or healthcare-associated MRSA strains.

Funding: None

Disclosure: Gabrielle M. Gussin, Stryker (Sage Products): Conducting studies in which antiseptic product is provided to participating hospitals and nursing homes. Clorox: Conducting studies in which antiseptic product is provided to participating hospitals and nursing homes. Medline: Conducting studies in which antiseptic product is provided to participating hospitals and nursing homes. Xttrium: Conducting studies in which antiseptic product is provided to participating hospitals and nursing homes. Mohamad Sater, Salary-Day Zero Diagnostics.


Type
Top Rated Posters Presentations
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

Full text views

Full text views reflects PDF downloads, PDFs sent to Google Drive, Dropbox and Kindle and HTML full text views.

Total number of HTML views: 0
Total number of PDF views: 26 *
View data table for this chart

* Views captured on Cambridge Core between 02nd November 2020 - 5th December 2020. This data will be updated every 24 hours.

Access
Hostname: page-component-b4dcdd7-qjxlp Total loading time: 0.303 Render date: 2020-12-05T09:08:05.575Z Query parameters: { "hasAccess": "1", "openAccess": "0", "isLogged": "0", "lang": "en" } Feature Flags last update: Sat Dec 05 2020 09:00:49 GMT+0000 (Coordinated Universal Time) Feature Flags: { "metrics": true, "metricsAbstractViews": false, "peerReview": true, "crossMark": true, "comments": true, "relatedCommentaries": true, "subject": true, "clr": false, "languageSwitch": true }

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.

Postdischarge Decolonization of Patients Harboring MRSA USA300 Strains: Secondary Analysis of the CLEAR 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.

Postdischarge Decolonization of Patients Harboring MRSA USA300 Strains: Secondary Analysis of the CLEAR 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.

Postdischarge Decolonization of Patients Harboring MRSA USA300 Strains: Secondary Analysis of the CLEAR Trial
Available formats
×
×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *