Targeted Intranasal Mupirocin To Prevent Colonization and Infection by Community-Associated Methicillin-Resistant Staphylococcus aureus Strains in Soldiers: a Cluster Randomized Controlled Trial

Abstract

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is an emerging pathogen that primarily manifests as uncomplicated skin and soft tissue infections. We conducted a cluster randomized, double-blind, placebo-controlled trial to determine whether targeted intranasal mupirocin therapy in CA-MRSA-colonized soldiers could prevent infection in the treated individual and prevent new colonization and infection within their study groups. We screened 3,447 soldiers comprising 14 training classes for CA-MRSA colonization from January to December 2005. Each training class was randomized to either the mupirocin or placebo study group, and the participants identified as CA-MRSA colonized were treated with either mupirocin or placebo. All participants underwent repeat screening after 8 to 10 weeks and were monitored for 16 weeks for development of infection. Of 3,447 participants screened, 134 (3.9%) were initially colonized with CA-MRSA. Five of 65 (7.7%; 95% confidence interval [95% CI], 4.0% to 11.4%) placebo-treated participants and 7 of 66 (10.6%; 95% CI, 7.9% to 13.3%) mupirocin-treated participants developed infections; the difference in the infection rate of the placebo-and mupirocin-treated groups was ؊2.9% (95% CI, ؊7.5% to 1.7%). Of those not initially colonized with CA-MRSA, 63 of 1,459 (4.3%; 95% CI, 2.7% to 5.9%) of the placebo group and 56 of 1,607 (3.5%; 95% CI, 2.6% to 5.2%) of the mupirocin group developed infections; the difference in the infection rate of the placebo and mupirocin groups was 0.8% (95% CI, ؊1.0% to 2.7%). Of 3,447 participants, 3,066 (89%) were available for the second sampling and completed follow-up. New CA-MRSA colonization occurred in 24 of 1,459 (1.6%; 95% CI, 0.05% to 2.8%) of the placebo group participants and 23 of 1,607 (1.4%; 95% CI, 0.05% to 2.3%) of the mupirocin group participants; the difference in the infection rate of the placebo and mupirocin groups was 0.2% (95% CI, ؊1.3% to 1.7%). Despite CA-MRSA eradication in colonized participants, this study showed no decrease in infections in either the mupirocin-treated individuals or within their study group. Furthermore, CA-MRSA eradication did not prevent new colonization within the study group.

Targeted Versus Universal Decolonization to Prevent ICU Infection

“…9,31,32 Mupirocin resistance has been reported in some studies of MRSA decolonization, 9,30 but not all such studies. 8,[32][33][34][35] MRSA resistance to chlorhexidine lacks a standard definition, but recent reports suggest that resistant strains are rare in the United States. 36,37 A gene encoding a multidrug efflux pump that is active against chlorhexidine has been reported in MRSA, 38 but its clinical significance is not understood.…”

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

“…[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.…”

“…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.…”

Are measures against MRSA transmission effective?

“…• arbeider i helsetjenesten • er bruker av hjemmesykepleie eller er innlagt i sykehus eller sykehjem • er planlagt innlagt i sykehus eller sykehjem eller henvist til poliklinikk • har nedsatt immunforsvar eller har individuelle risikofaktorer for baererskap 37 Smitteoppsporing og sanering kan tilbys alle MRSA-positive pasienter og deres husstandsmedlemmer og partnere, dersom de ønsker det og det ikke foreligger grunner til å fraråde sanering. Testing utover husstandsmedlemmer og partnere anbefales som hovedregel ikke, med mindre spesielle forhold tilsier dette.…”