Decolonization to Reduce Postdischarge Infection Risk among MRSA Carriers

Abstract

BACKGROUND Hospitalized patients who are colonized with methicillin-resistant Staphylococcus aureus (MRSA) are at high risk for infection after discharge. METHODS We conducted a multicenter, randomized, controlled trial of postdischarge hygiene education, as compared with education plus decolonization, in patients colonized with MRSA (carriers). Decolonization involved chlorhexidine mouthwash, baths or showers with chlorhexidine, and nasal mupirocin for 5 days twice per month for 6 months. Participants were followed for 1 year. The primary outcome was MRSA infection as defined according to Centers for Disease Control and Prevention (CDC) criteria. Secondary outcomes included MRSA infection determined on the basis of clinical judgment, infection from any cause, and infection-related hospitalization. All analyses were performed with the use of proportional-hazards models in the per-protocol population (all participants who underwent randomization, met the inclusion criteria, and survived beyond the recruitment hospitalization) and as-treated population (participants stratified according to adherence). RESULTS In the per-protocol population, MRSA infection occurred in 98 of 1063 participants (9.2%) in the education group and in 67 of 1058 (6.3%) in the decolonization group; 84.8% of the MRSA infections led to hospitalization. Infection from any cause occurred in 23.7% of the participants in the education group and 19.6% of those in the decolonization group; 85.8% of the infections led to hospitalization. The hazard of MRSA infection was significantly lower in the decolonization group than in the education group (hazard ratio, 0.70; 95% confidence interval [CI], 0.52 to 0.96; P=0.03; number needed to treat to prevent one infection, 30; 95% CI, 18 to 230); this lower hazard led to a lower risk of hospitalization due to MRSA infection (hazard ratio, 0.71; 95% CI, 0.51 to 0.99). The decolonization group had lower likelihoods of clinically judged infection from any cause (hazard ratio, 0.83; 95% CI, 0.70 to 0.99) and infection-related hospitalization (hazard ratio, 0.76; 95% CI, 0.62 to 0.93); treatment effects for secondary out-comes should be interpreted with caution owing to a lack of prespecified adjustment for multiple comparisons. In as-treated analyses, participants in the decolonization group who adhered fully to the regimen had 44% fewer MRSA infections than the education group (hazard ratio, 0.56; 95% CI, 0.36 to 0.86) and had 40% fewer infections from any cause (hazard ratio, 0.60; 95% CI, 0.46 to 0.78). Side effects (all mild) occurred in 4.2% of the participants. CONCLUSIONS Postdischarge MRSA decolonization with chlorhexidine and mupirocin led to a 30% lower risk of MRSA infection than education alone. (Funded by the AHRQ Healthcare-Associated Infections Program and others; ClinicalTrials.gov number, NCT01209234.)

Prevalence and Antimicrobial Susceptibility of Methicillin-Resistant Staphylococcus aureus in an Egyptian University Hospital

“…Antibiotic prescription practices should be based on the in vitro antibiotic susceptibility testing and should be reviewed by the hospital administers with implementation of policies aiming at reduction of their non-optimal use. Attention to MRSA prevention and control must remain a constant team effort, concerning all health care professionals, because the new therapeutic agents alone will not provide the long-term solution 55 . Adherence to the CDC recommendations 56 for preventing device-and procedure-associated infections is needed to further prevent SA infections…”

Characterization of Clinical MRSA Isolates from Northern Spain and Assessment of Their Susceptibility to Phage-Derived Antimicrobials

“…Both properties make them suitable decolonizing compounds, alternatives to mupirocin, with minimum effects on the surrounding microbiota. Indeed, decolonization of patients colonized with MRSA proved to be very useful for lowering their risk of infection [54]. Endolysins also exhibit properties that can be very useful for the treatment of chronic infections.…”

Prevalence, risk factors, phenotypic and molecular characteristics for Staphylococcus aureus carriage in community-based drug users in Guangzhou, China

“…Additionally, we found some S. aureus isolates displayed identical molecular characteristics, suggesting the possibility of cross-transmission between the communities and healthcare settings and this might be a potential risk for other populations. Relevant decolonization methods could be taken for drug users with MRSA carriage, which would help prevent further MRSA circulation [32].…”