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Infect Control Hosp Epidemiol. 2011 Sep;32(9):872-80. doi: 10.1086/661285.

Effectiveness of measures to eradicate Staphylococcus aureus carriage in patients with community-associated skin and soft-tissue infections: a randomized trial.

Author information

1
Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA. fritz_s@kids.wustl.edu

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.

Comment in

PMID:
21828967
PMCID:
PMC3528015
DOI:
10.1086/661285
[Indexed for MEDLINE]
Free PMC Article

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