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 G 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, David Royer, Ebbing Lautenbach, CDC Prevention Epicenters Program, Valerie C Cluzet, Jeffrey S Gerber, Joshua P Metlay, Irving Nachamkin, Theoklis E Zaoutis, Meghan F Davis, Kathleen G 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, David Royer, Ebbing Lautenbach, CDC Prevention Epicenters Program

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.