Chlorhexidine-Impregnated Cloths to Prevent Skin and Soft-Tissue Infection in Marine Recruits: A Cluster-Randomized, Double-Blind, Controlled Effectiveness Trial

SUMMARY Staphylococcus aureus is an important cause of skin and soft-tissue infections (SSTIs), endovascular infections, pneumonia, septic arthritis, endocarditis, osteomyelitis, foreign-body infections, and sepsis. Methicillin-resistant S. aureus (MRSA) isolates were once confined largely to hospitals, other health care environments, and patients frequenting these facilities. Since the mid-1990s, however, there has been an explosion in the number of MRSA infections reported in populations lacking risk factors for exposure to the health care system. This increase in the incidence of MRSA infection has been associated with the recognition of new MRSA clones known as community-associated MRSA (CA-MRSA). CA-MRSA strains differ from the older, health care-associated MRSA strains; they infect a different group of patients, they cause different clinical syndromes, they differ in antimicrobial susceptibility patterns, they spread rapidly among healthy people in the community, and they frequently cause infections in health care environments as well. This review details what is known about the epidemiology of CA-MRSA strains and the clinical spectrum of infectious syndromes associated with them that ranges from a commensal state to severe, overwhelming infection. It also addresses the therapy of these infections and strategies for their prevention.

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“…One study of chlorhexidine skin cleaning in a large cohort of soldiers did not show an effect on decreasing the incidence of SSTIs (997). VOL.…”

Section: Chlorhexidine Gluconate and Mrsa Decolonizationmentioning

confidence: 98%

Community-Associated Methicillin-ResistantStaphylococcus aureus: Epidemiology and Clinical Consequences of an Emerging Epidemic

2010

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“…[1][2][3][4][5] S. aureus SSTIs have become a significant public health issue for the US military over the last decade, affecting service members during training and overseas deployment. 4,[6][7][8] Cumulative SSTI rates during training range between 4-6%, 4,9,10 and SSTIs were estimated to be the cause of 41,951 ambulatory visits and 1,054 hospital admissions for active duty military members in 2014. 11,12 An evaluation of Department of Defense (DoD) beneficiaries (2005-2010) reported overall adjusted incidence rates (per 100,000 person-years) of 4.3 for S. aureus bacteremia and 144.5 for S. aureus SSTIs.…”

Section: Introductionmentioning

confidence: 99%

“…Among active-duty personnel, CA-MRSA SSTI incidence rate was 280.6, as compared to 165.8 for community-associated methicillin-susceptible S. aureus SSTIs. 8 With the growing burden of S. aureus disease, increasing antibiotic resistance, and limited efficacy of decolonization protocols, 9,10 there is substantial interest in development of a S. aureus vaccine for use in high risk populations. Although an effective S. aureus vaccine remains elusive, [13][14][15][16][17][18] there is general consensus on a multi-antigen approach to vaccine development, which targets T and B cell responses to S. aureus cell surface components, virulence factors and toxins.…”

Section: Introductionmentioning

confidence: 99%

Safety and immunogenicity of a recombinant Staphylococcus aureus α-toxoid and a recombinant Panton-Valentine leukocidin subunit, in healthy adults

Landrum

Lalani

Niknian³

et al. 2017

Human Vaccines & Immunotherapeutics

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We conducted a randomized, double-blind, placebo-controlled dose-escalation study in healthy adults to evaluate the safety and immunogenicity of recombinant Staphylococcus aureus candidate vaccine antigens, recombinant a-toxoid (rAT) and a sub-unit of Panton-Valentine leukocidin (rLukS-PV). 176 subjects were enrolled and randomized within 1 of 11 treatment cohorts: monovalent rAT or rLukS-PV dosages of 10, 25, 50, and 100 mg; bivalent rAT:rLukS dosages of 10:10, 25:25, and 50:50 mg; and alum or saline placebo. All subjects were assessed at Days 0, 7, 14, 28, and 84. Subjects in the 50:50 mg bivalent cohort received a second injection on Day 84 and were assessed on Days 98 and 112. Incidence and severity of reactogenicity and adverse events (AEs) were compared. Geometric mean serum concentrations (GMC) and neutralizing activity of anti-rAT and anti-rLukS-PV IgG were assessed. Reactogenicity incidence was significantly higher in vaccine than placebo recipients (77% versus 55%, respectively; p D 0.006). However, 77% of reactogenicity events were mild and 19% were moderate in severity. The AE incidence and severity were similar between the cohorts. All monovalent and bivalent rAT dosages resulted in a significant increase in the anti-rAT IgG and anti-rLukS-PV GMCs between day 0 and 28 compared with placebo, and persisted through Day 84. Exploratory subgroup analyses suggested a higher GMC and neutralizing antibody titers for the 50 mg monovalent or bivalent rAT and rLukS-PV dose as compared to the other doses. No booster effect was observed after administration of the second dose. We conclude that the rAT and rLukS-PV vaccine formulations were well-tolerated and had a favorable immunogenicity profile, producing antibody with neutralizing activity through day 84. There was no benefit observed with a booster dose of the vaccine.

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“…Specifically, the topical antimicrobial agents mupirocin and chlorhexidine have been prescribed for decades for patients in intensive care units and those undergoing surgery and dialysis as a means to eradicate S. aureus carriage to reduce the risk of nosocomial infections (2)(3)(4). During the current epidemic of cutaneous abscesses associated with the emergence of community-associated methicillin-resistant S. aureus (CA-MRSA) strains, these decolonization therapies have been extrapolated to outpatients in an effort to prevent recurrent skin infections (5)(6)(7)(8)(9).…”

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confidence: 99%

Mupirocin and Chlorhexidine Resistance in Staphylococcus aureus in Patients with Community-Onset Skin and Soft Tissue Infections

Fritz

Hogan

Camins

et al. 2013

Antimicrob Agents Chemother

128

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Decolonization measures, including mupirocin and chlorhexidine, are often prescribed to prevent Staphylococcus aureus skin and soft tissue infections (SSTI). The objective of this study was to determine the prevalence of high-level mupirocin and chlorhexidine resistance in S. aureus strains recovered from patients with SSTI before and after mupirocin and chlorhexidine administration and to determine whether carriage of a mupirocin-or chlorhexidine-resistant strain at baseline precluded S. aureus eradication. We recruited 1,089 patients with community-onset SSTI with or without S. aureus colonization. In addition to routine care, 483 patients were enrolled in a decolonization trial: 408 received intranasal mupirocin (with or without antimicrobial baths), and 258 performed chlorhexidine body washes. Patients were followed for up to 12 months with repeat colonization cultures. All S. aureus isolates were tested for high-level mupirocin and chlorhexidine resistance. At baseline, 23/1,089 (2.1%) patients carried a mupirocin-resistant S. aureus strain and 10/1,089 (0.9%) patients carried chlorhexidine-resistant S. aureus. Of 4 patients prescribed mupirocin, who carried a mupirocin-resistant S. aureus strain at baseline, 100% remained colonized at 1 month compared to 44% of the 324 patients without mupirocin resistance at baseline (P ‫؍‬ 0.041). Of 2 patients prescribed chlorhexidine, who carried a chlorhexidine-resistant S. aureus strain at baseline, 50% remained colonized at 1 month compared to 48% of the 209 patients without chlorhexidine resistance at baseline (P ‫؍‬ 1.0). The overall prevalence of mupirocin and chlorhexidine resistance is low in S. aureus isolates recovered from outpatients, but eradication efforts were less successful in patients carrying a mupirocin-resistant S. aureus strain at baseline.

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Chlorhexidine-Impregnated Cloths to Prevent Skin and Soft-Tissue Infection in Marine Recruits: A Cluster-Randomized, Double-Blind, Controlled Effectiveness Trial

Abstract: ClinicalTrials.gov identifier: NCT00475930.

Cited by 51 publications

References 28 publications

Community-Associated Methicillin-ResistantStaphylococcus aureus: Epidemiology and Clinical Consequences of an Emerging Epidemic

Community-Associated Methicillin-ResistantStaphylococcus aureus: Epidemiology and Clinical Consequences of an Emerging Epidemic

Safety and immunogenicity of a recombinant Staphylococcus aureus α-toxoid and a recombinant Panton-Valentine leukocidin subunit, in healthy adults

Mupirocin and Chlorhexidine Resistance in Staphylococcus aureus in Patients with Community-Onset Skin and Soft Tissue Infections

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