The effect of total household decolonization on clearance of colonization with methicillin-resistant staphylococcus aureus

Valerie C. Cluzet, Jeffrey S. Gerber, Joshua P. Metlay, Irving Nachamkin, Theoklis E. Zaoutis, Meghan F. Davis, Kathleen Julian, Darren R. Linkin, Susan E. Coffin, David J. Margolis, Judd E. Hollander, Warren B. Bilker, Xiaoyan Han, Rakesh D. Mistry, Laurence J. Gavin, Pam Tolomeo, Jacqueleen A. Wise, Mary K. Wheeler, Baofeng Hu, Neil O. Fishman & 2 others David Royer, Ebbing Lautenbach

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Abstract

OBJECTIVE To determine the impact of total household decolonization with intranasal mupirocin and chlorhexidine gluconate body wash on recurrent methicillin-resistant Staphylococcus aureus (MRSA) infection among subjects with MRSA skin and soft-tissue infection. DESIGN Three-arm nonmasked randomized controlled trial. SETTING Five academic medical centers in Southeastern Pennsylvania. PARTICIPANTS Adults and children presenting to ambulatory care settings with community-onset MRSA skin and soft-tissue infection (ie, index cases) and their household members. INTERVENTION Enrolled households were randomized to 1 of 3 intervention groups: (1) education on routine hygiene measures, (2) education plus decolonization without reminders (intranasal mupirocin ointment twice daily for 7 days and chlorhexidine gluconate on the first and last day), or (3) education plus decolonization with reminders, where subjects received daily telephone call or text message reminders. MAIN OUTCOME MEASURES Owing to small numbers of recurrent infections, this analysis focused on time to clearance of colonization in the index case. RESULTS Of 223 households, 73 were randomized to education-only, 76 to decolonization without reminders, 74 to decolonization with reminders. There was no significant difference in time to clearance of colonization between the education-only and decolonization groups (log-rank P=.768). In secondary analyses, compliance with decolonization was associated with decreased time to clearance (P=.018). CONCLUSIONS Total household decolonization did not result in decreased time to clearance of MRSA colonization among adults and children with MRSA skin and soft-tissue infection. However, subjects who were compliant with the protocol had more rapid clearance Trial registration.

Original languageEnglish (US)
Pages (from-to)1226-1233
Number of pages8
JournalInfection Control and Hospital Epidemiology
Volume37
Issue number10
DOIs
StatePublished - Oct 1 2016

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Methicillin-Resistant Staphylococcus aureus
Soft Tissue Infections
Education
Mupirocin
Skin
Text Messaging
Ambulatory Care
Ointments
Infection
Hygiene
Telephone
Randomized Controlled Trials
chlorhexidine gluconate

All Science Journal Classification (ASJC) codes

  • Epidemiology
  • Microbiology (medical)
  • Infectious Diseases

Cite this

Cluzet, V. C., Gerber, J. S., Metlay, J. P., Nachamkin, I., Zaoutis, T. E., Davis, M. F., ... Lautenbach, E. (2016). The effect of total household decolonization on clearance of colonization with methicillin-resistant staphylococcus aureus. Infection Control and Hospital Epidemiology, 37(10), 1226-1233. https://doi.org/10.1017/ice.2016.138
Cluzet, Valerie C. ; Gerber, Jeffrey S. ; Metlay, Joshua P. ; Nachamkin, Irving ; Zaoutis, Theoklis E. ; Davis, Meghan F. ; Julian, Kathleen ; Linkin, Darren R. ; Coffin, Susan E. ; Margolis, David J. ; Hollander, Judd E. ; Bilker, Warren B. ; Han, Xiaoyan ; Mistry, Rakesh D. ; Gavin, Laurence J. ; Tolomeo, Pam ; Wise, Jacqueleen A. ; Wheeler, Mary K. ; Hu, Baofeng ; Fishman, Neil O. ; Royer, David ; Lautenbach, Ebbing. / The effect of total household decolonization on clearance of colonization with methicillin-resistant staphylococcus aureus. In: Infection Control and Hospital Epidemiology. 2016 ; Vol. 37, No. 10. pp. 1226-1233.
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abstract = "OBJECTIVE To determine the impact of total household decolonization with intranasal mupirocin and chlorhexidine gluconate body wash on recurrent methicillin-resistant Staphylococcus aureus (MRSA) infection among subjects with MRSA skin and soft-tissue infection. DESIGN Three-arm nonmasked randomized controlled trial. SETTING Five academic medical centers in Southeastern Pennsylvania. PARTICIPANTS Adults and children presenting to ambulatory care settings with community-onset MRSA skin and soft-tissue infection (ie, index cases) and their household members. INTERVENTION Enrolled households were randomized to 1 of 3 intervention groups: (1) education on routine hygiene measures, (2) education plus decolonization without reminders (intranasal mupirocin ointment twice daily for 7 days and chlorhexidine gluconate on the first and last day), or (3) education plus decolonization with reminders, where subjects received daily telephone call or text message reminders. MAIN OUTCOME MEASURES Owing to small numbers of recurrent infections, this analysis focused on time to clearance of colonization in the index case. RESULTS Of 223 households, 73 were randomized to education-only, 76 to decolonization without reminders, 74 to decolonization with reminders. There was no significant difference in time to clearance of colonization between the education-only and decolonization groups (log-rank P=.768). In secondary analyses, compliance with decolonization was associated with decreased time to clearance (P=.018). CONCLUSIONS Total household decolonization did not result in decreased time to clearance of MRSA colonization among adults and children with MRSA skin and soft-tissue infection. However, subjects who were compliant with the protocol had more rapid clearance Trial registration.",
author = "Cluzet, {Valerie C.} and Gerber, {Jeffrey S.} and Metlay, {Joshua P.} and Irving Nachamkin and Zaoutis, {Theoklis E.} and Davis, {Meghan F.} and Kathleen Julian and Linkin, {Darren R.} and Coffin, {Susan E.} and Margolis, {David J.} and Hollander, {Judd E.} and Bilker, {Warren B.} and Xiaoyan Han and Mistry, {Rakesh D.} and Gavin, {Laurence J.} and Pam Tolomeo and Wise, {Jacqueleen A.} and Wheeler, {Mary K.} and Baofeng Hu and Fishman, {Neil O.} and David Royer and Ebbing Lautenbach",
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Cluzet, VC, Gerber, JS, Metlay, JP, Nachamkin, I, Zaoutis, TE, Davis, MF, Julian, K, Linkin, DR, Coffin, SE, Margolis, DJ, Hollander, JE, Bilker, WB, Han, X, Mistry, RD, Gavin, LJ, Tolomeo, P, Wise, JA, Wheeler, MK, Hu, B, Fishman, NO, Royer, D & Lautenbach, E 2016, 'The effect of total household decolonization on clearance of colonization with methicillin-resistant staphylococcus aureus', Infection Control and Hospital Epidemiology, vol. 37, no. 10, pp. 1226-1233. https://doi.org/10.1017/ice.2016.138

The effect of total household decolonization on clearance of colonization with methicillin-resistant staphylococcus aureus. / Cluzet, Valerie C.; Gerber, Jeffrey S.; Metlay, Joshua P.; Nachamkin, Irving; Zaoutis, Theoklis E.; Davis, Meghan F.; Julian, Kathleen; Linkin, Darren R.; Coffin, Susan E.; Margolis, David J.; Hollander, Judd E.; Bilker, Warren B.; Han, Xiaoyan; Mistry, Rakesh D.; Gavin, Laurence J.; Tolomeo, Pam; Wise, Jacqueleen A.; Wheeler, Mary K.; Hu, Baofeng; Fishman, Neil O.; Royer, David; Lautenbach, Ebbing.

In: Infection Control and Hospital Epidemiology, Vol. 37, No. 10, 01.10.2016, p. 1226-1233.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The effect of total household decolonization on clearance of colonization with methicillin-resistant staphylococcus aureus

AU - Cluzet, Valerie C.

AU - Gerber, Jeffrey S.

AU - Metlay, Joshua P.

AU - Nachamkin, Irving

AU - Zaoutis, Theoklis E.

AU - Davis, Meghan F.

AU - Julian, Kathleen

AU - Linkin, Darren R.

AU - Coffin, Susan E.

AU - Margolis, David J.

AU - Hollander, Judd E.

AU - Bilker, Warren B.

AU - Han, Xiaoyan

AU - Mistry, Rakesh D.

AU - Gavin, Laurence J.

AU - Tolomeo, Pam

AU - Wise, Jacqueleen A.

AU - Wheeler, Mary K.

AU - Hu, Baofeng

AU - Fishman, Neil O.

AU - Royer, David

AU - Lautenbach, Ebbing

PY - 2016/10/1

Y1 - 2016/10/1

N2 - OBJECTIVE To determine the impact of total household decolonization with intranasal mupirocin and chlorhexidine gluconate body wash on recurrent methicillin-resistant Staphylococcus aureus (MRSA) infection among subjects with MRSA skin and soft-tissue infection. DESIGN Three-arm nonmasked randomized controlled trial. SETTING Five academic medical centers in Southeastern Pennsylvania. PARTICIPANTS Adults and children presenting to ambulatory care settings with community-onset MRSA skin and soft-tissue infection (ie, index cases) and their household members. INTERVENTION Enrolled households were randomized to 1 of 3 intervention groups: (1) education on routine hygiene measures, (2) education plus decolonization without reminders (intranasal mupirocin ointment twice daily for 7 days and chlorhexidine gluconate on the first and last day), or (3) education plus decolonization with reminders, where subjects received daily telephone call or text message reminders. MAIN OUTCOME MEASURES Owing to small numbers of recurrent infections, this analysis focused on time to clearance of colonization in the index case. RESULTS Of 223 households, 73 were randomized to education-only, 76 to decolonization without reminders, 74 to decolonization with reminders. There was no significant difference in time to clearance of colonization between the education-only and decolonization groups (log-rank P=.768). In secondary analyses, compliance with decolonization was associated with decreased time to clearance (P=.018). CONCLUSIONS Total household decolonization did not result in decreased time to clearance of MRSA colonization among adults and children with MRSA skin and soft-tissue infection. However, subjects who were compliant with the protocol had more rapid clearance Trial registration.

AB - OBJECTIVE To determine the impact of total household decolonization with intranasal mupirocin and chlorhexidine gluconate body wash on recurrent methicillin-resistant Staphylococcus aureus (MRSA) infection among subjects with MRSA skin and soft-tissue infection. DESIGN Three-arm nonmasked randomized controlled trial. SETTING Five academic medical centers in Southeastern Pennsylvania. PARTICIPANTS Adults and children presenting to ambulatory care settings with community-onset MRSA skin and soft-tissue infection (ie, index cases) and their household members. INTERVENTION Enrolled households were randomized to 1 of 3 intervention groups: (1) education on routine hygiene measures, (2) education plus decolonization without reminders (intranasal mupirocin ointment twice daily for 7 days and chlorhexidine gluconate on the first and last day), or (3) education plus decolonization with reminders, where subjects received daily telephone call or text message reminders. MAIN OUTCOME MEASURES Owing to small numbers of recurrent infections, this analysis focused on time to clearance of colonization in the index case. RESULTS Of 223 households, 73 were randomized to education-only, 76 to decolonization without reminders, 74 to decolonization with reminders. There was no significant difference in time to clearance of colonization between the education-only and decolonization groups (log-rank P=.768). In secondary analyses, compliance with decolonization was associated with decreased time to clearance (P=.018). CONCLUSIONS Total household decolonization did not result in decreased time to clearance of MRSA colonization among adults and children with MRSA skin and soft-tissue infection. However, subjects who were compliant with the protocol had more rapid clearance Trial registration.

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