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PLoS One. 2015 May 27;10(5):e0128071. doi: 10.1371/journal.pone.0128071. eCollection 2015.

Randomized, Double-Blind, Placebo-Controlled Study on Decolonization Procedures for Methicillin-Resistant Staphylococcus aureus (MRSA) among HIV-Infected Adults.

Author information

1
Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America; Infectious Disease Clinic, Walter Reed National Military Medical Center, Bethesda, MD, United States of America.
2
Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America.
3
Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America; Infectious Disease Clinic, Naval Medical Center San Diego, San Diego, CA, United States of America.
4
Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America; Infectious Disease Service, San Antonio Military Medical Center, San Antonio, TX, United States of America.
5
Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America; Infectious Disease Clinic, Naval Medical Center, Portsmouth, VA, United States of America.
6
Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America.

Abstract

BACKGROUND:

HIV-infected persons have increased risk of MRSA colonization and skin and soft-tissue infections (SSTI). However, no large clinical trial has examined the utility of decolonization procedures in reducing MRSA colonization or infection among community-dwelling HIV-infected persons.

METHODS:

550 HIV-infected adults at four geographically diverse US military HIV clinics were prospectively screened for MRSA colonization at five body locations every 6 months during a 2-year period. Those colonized were randomized in a double-blind fashion to nasal mupirocin (Bactroban) twice daily and hexachlorophene (pHisoHex) soaps daily for 7 days compared to placeboes similar in appearance but without specific antibacterial activity. The primary endpoint was MRSA colonization at 6-months post-randomization; secondary endpoints were time to MRSA clearance, subsequent MRSA infections/SSTI, and predictors for MRSA clearance at the 6-month time point.

RESULTS:

Forty-nine (9%) HIV-infected persons were MRSA colonized and randomized. Among those with 6-month colonization data (80% of those randomized), 67% were negative for MRSA colonization in both groups (p = 1.0). Analyses accounting for missing 6-month data showed no significant differences could have been achieved. In the multivariate adjusted models, randomization group was not associated with 6-month MRSA clearance. The median time to MRSA clearance was similar in the treatment vs. placebo groups (1.4 vs. 1.8 months, p = 0.35). There was no difference on subsequent development of MRSA infections/SSTI (p = 0.89). In a multivariable model, treatment group, demographics, and HIV-specific factors were not predictive of MRSA clearance at the 6-month time point.

CONCLUSION:

A one-week decolonization procedure had no effect on MRSA colonization at the 6-month time point or subsequent infection rates among community-dwelling HIV-infected persons. More aggressive or novel interventions may be needed to reduce the burden of MRSA in this population.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT00631566.

PMID:
26018036
PMCID:
PMC4446345
DOI:
10.1371/journal.pone.0128071
[Indexed for MEDLINE]
Free PMC Article
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