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.

Design: Open-label, randomized controlled trial. Colonization status and recurrent SSTI were ascertained at 1 and 4 months.

Setting: Barnes-Jewish and St. Louis Children's Hospitals, St. Louis, Missouri, 2007-2009.

Participants: Three hundred patients with community-onset SSTI and S. aureus colonization in the nares, axilla, or inguinal folds.

Interventions: 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.

Conflict of interest statement

Potential conflicts of interest. B.C.C. receives research support from, serves as a consultant for, and is on the speaker’s bureau for Pfizer, Inc. All other authors report no conflicts of interest relevant to this article.

Figures

Figure 1

Flow of Participants through the StL Stars Trial.