title: The Effect of Total Household Decolonization on Clearance of Colonization With Methicillin-Resistant Staphylococcus aureus.
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. ClinicalTrials.gov identifier: NCT00966446 Infect Control Hosp Epidemiol 2016;1-8.
authors.affiliation: 1Division of Infectious Diseases,Department of Medicine,Perelman School of Medicine,University of Pennsylvania,Philadelphia,Pennsylvania.
authors.forename: Valerie C
authors.initials: VC
authors.lastname: Cluzet
authors.affiliation: 2Center for Clinical Epidemiology and Biostatistics,Perelman School of Medicine,University of Pennsylvania,Philadelphia,Pennsylvania.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Gerber
authors.affiliation: 5Department of Medicine,Massachusetts General Hospital,Harvard Medical School,Boston,Massachusetts.
authors.forename: Joshua P
authors.initials: JP
authors.lastname: Metlay
authors.affiliation: 6Department of Pathology and Laboratory Medicine,Perelman School of Medicine,University of Pennsylvania,Philadelphia,Pennsylvania.
authors.forename: Irving
authors.initials: I
authors.lastname: Nachamkin
authors.affiliation: 2Center for Clinical Epidemiology and Biostatistics,Perelman School of Medicine,University of Pennsylvania,Philadelphia,Pennsylvania.
authors.forename: Theoklis E
authors.initials: TE
authors.lastname: Zaoutis
authors.affiliation: 7Department of Environmental Health Sciences,Johns Hopkins Bloomberg School of Public Health,Baltimore,Maryland.
authors.forename: Meghan F
authors.initials: MF
authors.lastname: Davis
authors.affiliation: 8Division of Infectious Diseases,Penn State Hershey Medical Center,Hershey,Pennsylvania.
authors.forename: Kathleen G
authors.initials: KG
authors.lastname: Julian
authors.affiliation: 1Division of Infectious Diseases,Department of Medicine,Perelman School of Medicine,University of Pennsylvania,Philadelphia,Pennsylvania.
authors.forename: Darren R
authors.initials: DR
authors.lastname: Linkin
authors.affiliation: 2Center for Clinical Epidemiology and Biostatistics,Perelman School of Medicine,University of Pennsylvania,Philadelphia,Pennsylvania.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Coffin
authors.affiliation: 2Center for Clinical Epidemiology and Biostatistics,Perelman School of Medicine,University of Pennsylvania,Philadelphia,Pennsylvania.
authors.forename: David J
authors.initials: DJ
authors.lastname: Margolis
authors.affiliation: 10Department of Emergency Medicine,Thomas Jefferson University Hospital,Philadelphia,Pennsylvania.
authors.forename: Judd E
authors.initials: JE
authors.lastname: Hollander
authors.affiliation: 2Center for Clinical Epidemiology and Biostatistics,Perelman School of Medicine,University of Pennsylvania,Philadelphia,Pennsylvania.
authors.forename: Warren B
authors.initials: WB
authors.lastname: Bilker
authors.affiliation: 2Center for Clinical Epidemiology and Biostatistics,Perelman School of Medicine,University of Pennsylvania,Philadelphia,Pennsylvania.
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Han
authors.affiliation: 11Section of Emergency Medicine,Children's Hospital Colorado,Aurora,Colorado.
authors.forename: Rakesh D
authors.initials: RD
authors.lastname: Mistry
authors.affiliation: 12Department of Emergency Medicine,Penn Presbyterian Medical Center,Philadelphia,Pennsylvania.
authors.forename: Laurence J
authors.initials: LJ
authors.lastname: Gavin
authors.affiliation: 2Center for Clinical Epidemiology and Biostatistics,Perelman School of Medicine,University of Pennsylvania,Philadelphia,Pennsylvania.
authors.forename: Pam
authors.initials: P
authors.lastname: Tolomeo
authors.affiliation: 2Center for Clinical Epidemiology and Biostatistics,Perelman School of Medicine,University of Pennsylvania,Philadelphia,Pennsylvania.
authors.forename: Jacqueleen A
authors.initials: JA
authors.lastname: Wise
authors.affiliation: 2Center for Clinical Epidemiology and Biostatistics,Perelman School of Medicine,University of Pennsylvania,Philadelphia,Pennsylvania.
authors.forename: Mary K
authors.initials: MK
authors.lastname: Wheeler
authors.affiliation: 6Department of Pathology and Laboratory Medicine,Perelman School of Medicine,University of Pennsylvania,Philadelphia,Pennsylvania.
authors.forename: Baofeng
authors.initials: B
authors.lastname: Hu
authors.affiliation: 1Division of Infectious Diseases,Department of Medicine,Perelman School of Medicine,University of Pennsylvania,Philadelphia,Pennsylvania.
authors.forename: Neil O
authors.initials: NO
authors.lastname: Fishman
authors.affiliation: 13Department of Biology,Lincoln University,Lincoln University,Pennsylvania.
authors.forename: David
authors.initials: D
authors.lastname: Royer
authors.affiliation: 1Division of Infectious Diseases,Department of Medicine,Perelman School of Medicine,University of Pennsylvania,Philadelphia,Pennsylvania.
authors.forename: Ebbing
authors.initials: E
authors.lastname: Lautenbach
mesh_terms: D000046:Academic Medical Centers; D000281:Administration, Intranasal; D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D002710:Chlorhexidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D017714:Community-Acquired Infections; D005191:Family Characteristics; D005192:Family Health; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects* / Q000302:isolation & purification; D008875:Middle Aged; D016712:Mupirocin / Q000008:administration & dosage*; D010349:Patient Compliance; D010353:Patient Education as Topic; D010414:Pennsylvania; D012008:Recurrence; D018461:Soft Tissue Infections / Q000188:drug therapy* / Q000382:microbiology; D013203:Staphylococcal Infections / Q000188:drug therapy*; D013207:Staphylococcal Skin Infections; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D016712:Mupirocin; C010882:chlorhexidine gluconate; D002710:Chlorhexidine