title: Effectiveness of measures to eradicate Staphylococcus aureus carriage in patients with community-associated skin and soft-tissue infections: a randomized trial.
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.
  
  
  METHODS
  Open-label, randomized controlled trial. Colonization status and recurrent SSTI were ascertained at 1 and 4 months.
  
  
  METHODS
  Barnes-Jewish and St. Louis Children's Hospitals, St. Louis, Missouri, 2007-2009.
  
  
  METHODS
  Three hundred patients with community-onset SSTI and S. aureus colonization in the nares, axilla, or inguinal folds.
  
  
  METHODS
  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.
authors.affiliation: Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA. fritz_s@kids.wustl.edu
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Fritz
authors.forename: Bernard C
authors.initials: BC
authors.lastname: Camins
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Eisenstein
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Fritz
authors.forename: Emma K
authors.initials: EK
authors.lastname: Epplin
authors.forename: Carey-Ann
authors.initials: CA
authors.lastname: Burnham
authors.forename: Jonathan
authors.initials: J
authors.lastname: Dukes
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Storch
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage; D001494:Baths; D002353:Carrier State / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D002710:Chlorhexidine / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D017714:Community-Acquired Infections / Q000188:drug therapy; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D016712:Mupirocin / Q000008:administration & dosage*; D009666:Nose / Q000382:microbiology; D010349:Patient Compliance; D010353:Patient Education as Topic; D012973:Sodium Hypochlorite / Q000008:administration & dosage*; D018461:Soft Tissue Infections / Q000188:drug therapy* / Q000628:therapy; D013207:Staphylococcal Skin Infections / Q000188:drug therapy* / Q000628:therapy; D013211:Staphylococcus aureus; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D016712:Mupirocin; D012973:Sodium Hypochlorite; D002710:Chlorhexidine