title: Household versus individual approaches to eradication of community-associated Staphylococcus aureus in children: a randomized trial.
abstract: BACKGROUND
  Community-associated Staphylococcus aureus infections often affect multiple members of a household. We compared 2 approaches to S. aureus eradication: decolonizing the entire household versus decolonizing the index case alone.
  
  
  METHODS
  An open-label, randomized trial enrolled 183 pediatric patients (cases) with community-onset S. aureus skin abscesses and colonization of anterior nares, axillae, or inguinal folds from 2008 to 2009 at primary and tertiary centers. Participants were randomized to decolonization of the case alone (index group) or of all household members (household group). The 5-day regimen included hygiene education, twice-daily intranasal mupirocin, and daily chlorhexidine body washes. Colonization of cases and subsequent skin and soft tissue infection (SSTI) in cases and household contacts were ascertained at 1, 3, 6, and 12 months.
  
  
  RESULTS
  Among 147 cases with 1-month colonization data, modified intention-to-treat analysis revealed S. aureus eradication in 50% of cases in the index group and 51% in the household group (P = 1.00). Among 126 cases completing 12-month follow-up, S. aureus was eradicated from 54% of the index group versus 66% of the household group (P = .28). Over 12 months, recurrent SSTI was reported in 72% of cases in the index group and 52% in the household group (P = .02). SSTI incidence in household contacts was significantly lower in the household versus index group during the first 6 months; this trend continued at 12 months.
  
  
  CONCLUSIONS
  Household decolonization was not more effective than individual decolonization in eradicating community-associated S. aureus carriage from cases. However, household decolonization reduced the incidence of subsequent SSTI in cases and their household contacts.
  
  
  BACKGROUND
  NCT00731783.
authors.affiliation: Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri 63110, USA. fritz_s@kids.wustl.edu
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Fritz
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Hogan
authors.forename: Genevieve
authors.initials: G
authors.lastname: Hayek
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Eisenstein
authors.forename: Marcela
authors.initials: M
authors.lastname: Rodriguez
authors.forename: Emma K
authors.initials: EK
authors.lastname: Epplin
authors.forename: Jane
authors.initials: J
authors.lastname: Garbutt
authors.forename: Victoria J
authors.initials: VJ
authors.lastname: Fraser
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage; D001365:Axilla / Q000382:microbiology; 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; D005191:Family Characteristics; D005260:Female; D006119:Groin / Q000382:microbiology; D006801:Humans; D007223:Infant; D057194:Intention to Treat Analysis; D008297:Male; D016712:Mupirocin / Q000008:administration & dosage; D009666:Nose / Q000382:microbiology; D010349:Patient Compliance; D010353:Patient Education as Topic; D018461:Soft Tissue Infections / Q000188:drug therapy* / Q000517:prevention & control / Q000628:therapy; D013207:Staphylococcal Skin Infections / Q000188:drug therapy* / Q000517:prevention & control / Q000628:therapy; D013211:Staphylococcus aureus; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D016712:Mupirocin; D002710:Chlorhexidine