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Community-associated Staphylococcus aureus (CA-SA) causes recurrent skin and soft tissue infections (SSTI). Eradication of CA-SA colonization may prevent recurrent skin infections. However, decolonization regimens traditionally used in the healthcare setting have not been evaluated in the community.
Objective:
To evaluate the efficacy of three different decolonization methods in the eradication of S. aureus carriage in patients presenting with community-acquired SSTI.
Methods:
Patients with acute SSTI who were colonized with S. aureus were enrolled into a 4-arm (n=300; 75 in each arm) randomized controlled trial. All participants were educated on proper personal hygiene measures to prevent recurrences of SSTI as recommended in the literature. The control group only received the educational materials while the intervention groups received education materials and were treated with a decolonization strategy. The intervention arms were (i) application of 2% mupirocin ointment to both anterior nares twice daily for 5 days, (ii) 2% mupirocin ointment intranasally in addition to daily showers with 4% chlorhexidine solution for 5 days, and (iii) 2% mupirocin ointment intranasally in addition to daily 30-minute soaking in dilute bleach water daily for 5 days. Patients were screened for colonization by obtaining swab cultures from the nares, axillae, and both groins at 1 month and 4 months post intervention. Efficacy was analyzed by a modified intention-to-treat analysis. Only evaluable patients were included in the final analysis. Proportions of decolonized patients were compared using chi-square analysis. A P-value of ≤ 0.05 was considered significant.
Results:
300 patients were enrolled into the trial. 64% (193/300) were children and 54% (161/300) were female. Mean age was 17.8 ± 16.4 years (0.6-70 years). Majority were African-Americans (66%; 198/300). The sites of infection included: the extremities (40%; 120/300), the groin/perineum/buttocks (39.3%; 118/300), the trunk (19%; 57/300), and the head (9.3%; 29/300). Most common adverse reactions included: dry skin (7.7%; 23/300) and rash (2.7%; 8/300). 77% (174/225) found using the mupirocin easy, 75% reported daily chlorhexidine showers were easy to perform, and 68% (51/75) found the daily bleach baths easy to perform. 21% (47/225) reported having another infection within four months of enrollment into the trial.
Conclusions:
In a randomized controlled trial, all three regimens were effective at eradicating S. aureus colonization at 1 month post-intervention. At four months post-intervention, the nasal application of 2% mupirocin and bleach baths was more effective than the other regimens at eradicating S. aureus colonization. All treatment arms were well-tolerated.
