Comparative Effectiveness Study of Home-Based Interventions to Prevent CA-MRSA Infection Recurrence

• Published in: Antibiotics (Basel) Vol. 10; no. 9; p. 1105
• Main Authors: Tobin, Jonathan N., Hower, Suzanne, D’Orazio, Brianna M., Pardos de la Gándara, María, Evering, Teresa H., Khalida, Chamanara, Ramachandran, Jessica, González, Leidy Johana, Kost, Rhonda G., Vasquez, Kimberly S., de Lencastre, Hermínia, Tomasz, Alexander, Coller, Barry S., Vaughan, Roger
• Format: Journal Article
• Language: English
• Published: Basel MDPI AG 13.09.2021; MDPI
• Subjects: Ambulatory care; antibiotic-resistance; Chlorhexidine; Colonization; Community; community-based participatory research (CBPR); Contamination; Decolonization; Decontamination; Drug resistance; Electronic health records; Electronic medical records; Households; Hygiene; Intervention; Medical personnel; Methicillin; methicillin-resistant Staphylococcus aureus (MRSA); Mupirocin; Participatory research; Patient satisfaction; Patients; Practice research; practice-based research network (PBRN); Quality of life; randomized clinical trial (RCT); Recurrent infection; skin and soft tissue infection (SSTI); Soft tissues; Staphylococcus aureus; Staphylococcus infections; United States > US
• ISSN: 2079-6382; 2079-6382
• DOI: 10.3390/antibiotics10091105

Recurrent skin and soft tissue infections (SSTI) caused by Community-Associated Methicillin-Resistant Staphylococcus aureus (CA-MRSA) or Methicillin-Sensitive Staphylococcus aureus (CA-MSSA) present treatment challenges. This community-based trial examined the effectiveness of an evidence-based intervention (CDC Guidelines, topical decolonization, surface decontamination) to reduce SSTI recurrence, mitigate household contamination/transmission, and improve patient-reported outcomes. Participants (n = 186) were individuals with confirmed MRSA(+)/MSSA(+) SSTIs and their household members. During home visits; Community Health Workers/Promotoras provided hygiene instructions; a five-day supply of nasal mupirocin; chlorhexidine for body cleansing; and household disinfecting wipes (Experimental; EXP) or Usual Care Control (UC CON) pamphlets. Primary outcome was six-month SSTI recurrence from electronic health records (EHR). Home visits (months 0; 3) and telephone assessments (months 0; 1; 6) collected self-report data. Index patients and participating household members provided surveillance culture swabs. Secondary outcomes included household surface contamination; household member colonization and transmission; quality of life; and satisfaction with care. There were no significant differences in SSTI recurrence between EXP and UC in the intent-to-treat cohort (n = 186) or the enrolled cohort (n = 119). EXP participants showed reduced but non-significant colonization rates. EXP and UC did not differ in household member transmission, contaminated surfaces, or patient-reported outcomes. This intervention did not reduce clinician-reported MRSA/MSSA SSTI recurrence. Taken together with other recent studies that employed more intensive decolonization protocols, it is possible that a promotora-delivered intervention instructing treatment for a longer or repetitive duration may be effective and should be examined by future studies.