Chlorhexidine and Mupirocin for Clearance of Methicillin-Resistant Staphylococcus aureus Colonization After Hospital Discharge: A Secondary Analysis of the Changing Lives by Eradicating Antibiotic Resistance Trial.

Autor:	Miller LG; Infectious Disease Clinical Outcomes Research Unit, Division of Infectious Disease, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California, USA., Singh R; Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California, USA., Eells SJ; Infectious Disease Clinical Outcomes Research Unit, Division of Infectious Disease, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California, USA., Gillen D; Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California, USA., McKinnell JA; Infectious Disease Clinical Outcomes Research Unit, Division of Infectious Disease, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California, USA., Park S; Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California, USA., Tjoa T; Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California, USA., Chang J; Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California, USA., Rashid S; Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California, USA., Macias-Gil R; Infectious Disease Clinical Outcomes Research Unit, Division of Infectious Disease, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California, USA., Heim L; Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California, USA., Gombosev A; Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California, USA., Kim D; Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California, USA., Cui E; Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California, USA., Lequieu J; Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California, USA., Cao C; Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California, USA., Hong SS; Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California, USA., Peterson EM; Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California, USA., Evans KD; Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California, USA., Launer B; Infectious Disease Clinical Outcomes Research Unit, Division of Infectious Disease, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California, USA., Tam S; Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California, USA., Bolaris M; Infectious Disease Clinical Outcomes Research Unit, Division of Infectious Disease, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California, USA., Huang SS; Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California, USA.
Jazyk:	angličtina
Zdroj:	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2023 Feb 08; Vol. 76 (3), pp. e1208-e1216.
DOI:	10.1093/cid/ciac402
Abstrakt:	Background: The CLEAR Trial demonstrated that a multisite body decolonization regimen reduced post-discharge infection and hospitalization in methicillin-resistant Staphylococcus aureus (MRSA) carriers. Here, we describe decolonization efficacy. Methods: We performed a large, multicenter, randomized clinical trial of MRSA decolonization among adult patients after hospital discharge with MRSA infection or colonization. Participants were randomized 1:1 to either MRSA prevention education or education plus decolonization with topical chlorhexidine, oral chlorhexidine, and nasal mupirocin. Participants were swabbed in the nares, throat, axilla/groin, and wound (if applicable) at baseline and 1, 3, 6, and 9 months after randomization. The primary outcomes of this study are follow-up colonization differences between groups. Results: Among 2121 participants, 1058 were randomized to decolonization. By 1 month, MRSA colonization was lower in the decolonization group compared with the education-only group (odds ration [OR] = 0.44; 95% confidence interval [CI], .36-.54; P ≤ .001). A similar magnitude of reduction was seen in the nares (OR = 0.34; 95% CI, .27-.42; P < .001), throat (OR = 0.55; 95% CI, .42-.73; P < .001), and axilla/groin (OR = 0.57; 95% CI, .43-.75; P < .001). These differences persisted through month 9 except at the wound site, which had a relatively small sample size. Higher regimen adherence was associated with lower MRSA colonization (P ≤ .01). Conclusions: In a randomized, clinical trial, a repeated post-discharge decolonization regimen for MRSA carriers reduced MRSA colonization overall and at multiple body sites. Higher treatment adherence was associated with greater reductions in MRSA colonization. Competing Interests: Potential conflicts of interest. L. G. M. has served as a consultant or has received grants from Gilead Science, Achaogen, Merck, Abbott, Medline, and Cepheid and has received financial or material support from Medline, Sage, and Xttrium. R. S. has received financial or material support from Medline, Molnlycke, Sage, and Xttrium. L. H. has received financial or material support from Medline, Molnlycke, Sage, and Xttrium. J. A. M. has received research funding from Achaogen, Theravance Biopharma, Allergan, Cempra, Melinta Therapeutics, Menarini Group, Medline, and Thermo Fisher Scientific and has received financial or material support from Medline, Sage, and Xttrium. S. S. Huang has received financial or material support from Medline, Molnlycke, Sage, and Xttrium. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed. (© The Author(s) 2022. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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