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J Clin Microbiol. 2016 Nov;54(11):2735-2742. Epub 2016 Aug 24.

Chlorhexidine and Mupirocin Susceptibility of Methicillin-Resistant Staphylococcus aureus Isolates in the REDUCE-MRSA Trial.

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Department of Medicine (Infectious Diseases), Rush University Medical Center, Chicago, Illinois, USA
Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA.
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA.
Hospital Corporation of America, Nashville, Tennessee, USA.
Division of Internal Medicine, Texas A&M Health Science Center College of Medicine, Houston, Texas, USA.
Department of Medicine (Infectious Diseases), Rush University Medical Center, Chicago, Illinois, USA.
Cook County Health and Hospitals System, Chicago, Illinois, USA.
Office of HAI Prevention Research and Evaluation, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Division of Infectious Diseases, University of California-Irvine School of Medicine, Orange, California, USA.


Whether targeted or universal decolonization strategies for the control of methicillin-resistant Staphylococcus aureus (MRSA) select for resistance to decolonizing agents is unresolved. The REDUCE-MRSA trial (ClinicalTrials registration no. NCT00980980) provided an opportunity to investigate this question. REDUCE-MRSA was a 3-arm, cluster-randomized trial of either screening and isolation without decolonization, targeted decolonization with chlorhexidine and mupirocin, or universal decolonization without screening to prevent MRSA infection in intensive-care unit (ICU) patients. Isolates from the baseline and intervention periods were collected and tested for susceptibility to chlorhexidine gluconate (CHG) by microtiter dilution; mupirocin susceptibility was tested by Etest. The presence of the qacA or qacB gene was determined by PCR and DNA sequence analysis. A total of 3,173 isolates were analyzed; 2 were nonsusceptible to CHG (MICs, 8 μg/ml), and 5/814 (0.6%) carried qacA or qacB At baseline, 7.1% of MRSA isolates expressed low-level mupirocin resistance, and 7.5% expressed high-level mupirocin resistance. In a mixed-effects generalized logistic regression model, the odds of mupirocin resistance among clinical MRSA isolates or MRSA isolates acquired in an ICU in intervention versus baseline periods did not differ across arms, although estimates were imprecise due to small numbers. Reduced susceptibility to chlorhexidine and carriage of qacA or qacB were rare among MRSA isolates in the REDUCE-MRSA trial. The odds of mupirocin resistance were no different in the intervention versus baseline periods across arms, but the confidence limits were broad, and the results should be interpreted with caution.

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