MRSA Decolonization Fails in HIV Patients

Laird Harrison

October 17, 2013

SAN FRANCISCO — Hexachlorophene and mupirocin do not effectively remove colonies of methicillin-resistant Staphylococcus aureus (MRSA) from people with HIV, a new study shows.

"For several years before the study began, we noticed a large increase in MRSA infections in patients with HIV," said Nancy Crum-Cianflone, MD, an infectious disease researcher at the US Naval Medical Center in Poway, California.

"We wanted to see if we could come up with a strategy to reduce MRSA infections," which are about 18 times higher in HIV-infected patients than in the general population, she reported.

"We were surprised to find that the strategy was not effective," she told Medscape Medical News.

Dr. Crum-Cianflone presented the study results here at IDWeek 2013.

To see if patients could wash away an MRSA infection, the researchers screened HIV-infected adults at 4 geographically diverse military HIV clinics in the United States. They swabbed the nares, pharynx, axilla, groin, and perirectal areas of 550 patients for the bacterium every 6 months for 2 years.

We were surprised to find that the strategy was not effective.

During the study period, 49 patients were colonized with MRSA. Of these, 21 were instructed to wash their bodies twice daily with hexachlorophene and to apply mupirocin to their noses for 7 days. Another 28 were instructed to use a placebo nasal ointment and a soap similar in appearance to the hexachlorophene soap, but without antibacterial activity, for 7 days.

There were no significant differences between the 2 groups at baseline. The median time to MRSA clearance was slightly longer in the treatment group than in the placebo group, but the difference was not significant (1.2 vs 1.7 months; P = .62).

During the follow-up period, there was no difference in the number of patients who developed skin and soft tissue or MRSA infection in the treatment and placebo groups (4 vs 6; P = .53).

Multivariate adjusted models revealed that randomization group was not associated with MRSA clearance. However, the researchers did find that younger patients and those with higher CD4 counts were more likely to clear MRSA infections.

MRSA Declining

Routine screening for MRSA might not be needed in patients with HIV, said Dr. Crum-Cianflone. It is possible that the problem might simply have gotten better in the years since researchers began working on it, she explained.

"Even the placebo group was not colonized much over time," she said. "Very few patients developed an infection over the 2-year follow-up period. Maybe these patients are healthier now. Maybe they're on better therapies."

MRSA rates in general have declined in recent years, she added. "For the time being, clinicians can be reassured that they really don't need to be aggressive in screening and decolonizing these patients," she said.

Clinicians should treat HIV-positive people with MRSA infections much the same as they treat HIV-negative people with these infections, said Joel Gallant, MD, associate medical director of specialty services at the Southwest CARE Center in Santa Fe, New Mexico, who was asked by Medscape Medical News to comment on the findings.

"Although this study had a large initial size, it is not definitive by any means," said Dr. Gallant, who was not involved in the study. "Attempts at decolonization in HIV-negative people have been pretty disappointing overall, but there have been mixed data, with some people reporting pretty good success."

This study was funded by the US National Institute of Allergy and Infectious Diseases. Dr. Crum-Cianflone and Dr. Gallant have disclosed no relevant financial relationships.

IDWeek 2013: Abstract 352. Presented October 3, 2013.


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