Household Eradication of S. aureus Reduces Infections

January 05, 2012

NEW YORK (Reuters Health) Jan 04 - When a child has recurrent Staphylococcus aureus skin or soft tissue infections, decolonizing all household members rather than just that child leads to a lower incidence of infections in the following months, a randomized trial has shown.

The new study, by Dr. Stephanie A. Fritz and colleagues at Washington University School of Medicine in St. Louis, Missouri, involved 183 pediatric patients with S. aureus skin abscesses. In half the cases, just the index patient underwent decolonization after the acute SSTI had healed, while in the other half all household members performed the procedure.

The decolonization protocol was a five-day regimen of twice-daily intranasal mupirocin and daily chlorhexidine body washes. All participants were instructed to avoid sharing items such as towels or brushes, to use liquid soaps, and to launder bed linens at least weekly.

Eradication rates of S. aureus in the index patients at one month were similar in the two arms of the study: 51% when the household was treated and 50% in the individual decolonization group, the authors report. Corresponding rates at 12 months were 66% vs 54% (p=0.28).

However, one-year rates of skin and soft tissue infections (SSTI) in the index patients were significantly lower in the household group (52%) than in the individual group (72%; p=0.02), the investigators found.

Furthermore, SSTI incidence among household members at six months was 9% in the household decolonization group versus 16% in the individual decolonization arm (p=0.04), with a trend still evident at 12 months (16% vs 22%, p=0.10), Dr. Fritz and colleagues reported in Clinical Infectious Diseases online December 23.

The authors note that a community-associated S. aureus epidemic is affecting millions of individuals. "This entity is particularly challenging within households, where the reservoir of S. aureus may perpetuate ongoing disease," they say.

"This is the first randomized trial of S. aureus decolonization strategies in the community setting to demonstrate a reduction in the burden of SSTI," the researchers add.

"However," they continue, "this study is only a first step in demonstrating that a household approach can decrease the impact of S. aureus, as >50% of cases in the household group reported recurrent SSTI over a one-year period."


Clin Infect Dis 2011.


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