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Effectiveness of Measures to Eradicate Staphylococcus aureus Carriage in Patients with Community-Associated Skin and Soft-Tissue Infections: A Randomized Trial

Stephanie A. Fritz MD MSCI, Bernard C. Camins MD MSCR, Kimberly A. Eisenstein BS, Joseph M. Fritz MD, Emma K. Epplin BS, Carey-Ann Burnham PhD, Jonathan Dukes MPH and Gregory A. Storch MD
Infection Control and Hospital Epidemiology
Vol. 32, No. 9 (September 2011), pp. 872-880
DOI: 10.1086/661285
Stable URL: http://www.jstor.org/stable/10.1086/661285
Page Count: 9
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Effectiveness of Measures to Eradicate Staphylococcus aureus Carriage in Patients with Community-Associated Skin and Soft-Tissue Infections: A Randomized Trial
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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 ( vs controls), 55% of those in the mupirocin and chlorhexidine group (), and 63% off those in the mupirocin and bleach group (). Of 229 participants with 4-month colonization data, eradication rates were 48% in the control group, 56% in the mupirocin only group ( vs controls), 54% in the mupirocin and chlorhexidine group (), and 71% in the mupirocin and bleach group (). 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.

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