The community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) epidemic poses a significant health and economic burden. As CA-MRSA is now the predominant MRSA clone in the community and in many healthcare settings, clinicians and infection prevention specialists face new challenges. The community has become an important and expanding reservoir for the spread of virulent CA-MRSA strains into hospitals, likely increasing the severity of nosocomial MRSA infections. Efforts are needed to mitigate the spread of MRSA in the community and decrease the burden of CA-MRSA infections. Households are significant reservoirs for MRSA transmission and important targets for MRSA eradication. Our prior study demonstrated that a one-time decolonization regimen performed by all household members reduced (but did not eliminate) the incidence of skin and soft tissue infection (SSTI) in index patients and household contacts. Given the widespread dissemination of CA-MRSA and risk for ongoing exposure, a periodic approach to personal decolonization may provide sustained protection against CA-MRSA reacquisition. Additionally, environmental surfaces in households of patients with MRSA infection are frequently and persistently contaminated with MRSA; thus, decontamination of household surfaces may limit the acquisition and spread of MRSA. Pediatric patients with CA-MRSA infection and their household members will be recruited to participate in a pragmatic comparative effectiveness trial evaluating personal and household environmental hygiene strategies to decrease the burden of CA-MRSA disease. Specifically, all participants (index patients and their household contacts) will perform a baseline 5-day MRSA decolonization protocol consisting of enhanced hygiene measures, application of mupirocin antibiotic ointment to the anterior nares twice daily, and daily body washes with chlorhexidine antiseptic. Following the 5-day baseline decolonization regimen, households will be randomized to one of three intervention groups: 1) Periodic personal decolonization performed by all household members, to include chlorhexidine body washes twice weekly for 3 months and application of intranasal mupirocin for 5 consecutive days each month for 3 months; 2) Household environmental hygiene, including targeted cleaning of household surfaces and laundering of bed linens, weekly for 3 months; and 3) Integrated periodic personal decolonization and household environmental hygiene for 3 months. Households will be followed for 9 months to measure the prevalence of MRSA colonization in the participants and the household environment and to document the incidence of recurrent SSTI. Molecular strain typing will be performed on all recovered MRSA isolates to illuminate transmission dynamics. Each recovered MRSA isolate will be tested for resistance to mupirocin, chlorhexidine, and systemic antibiotics. The proposed trial will identify best strategie for curtailing the incidence of CA-MRSA infections, thus reducing healthcare utilization for CA-MRSA treatment, potentially preventing additional migration of virulent CA-MRSA strains into hospitals.

Public Health Relevance

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is a significant public health problem. The proposed research will investigate the effectiveness of periodic personal and household environmental hygiene measures in interrupting the spread of CA-MRSA and preventing CA-MRSA infections.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Research Project (R01)
Project #
5R01HS024269-04
Application #
9495698
Study Section
Healthcare Patient Safety and Quality Improvement Research (HSQR)
Program Officer
Burwen, Dale R
Project Start
2015-09-01
Project End
2020-06-30
Budget Start
2018-07-01
Budget End
2019-06-30
Support Year
4
Fiscal Year
2018
Total Cost
Indirect Cost
Name
Washington University
Department
Pediatrics
Type
Schools of Medicine
DUNS #
068552207
City
Saint Louis
State
MO
Country
United States
Zip Code
63130
Hogan, Patrick G; Rodriguez, Marcela; Spenner, Allison M et al. (2018) Impact of Systemic Antibiotics on Staphylococcus aureus Colonization and Recurrent Skin Infection. Clin Infect Dis 66:191-197
Parrish, Katelyn L; Hogan, Patrick G; Clemons 2nd, Arvon A et al. (2018) Spatial relationships among public places frequented by families plagued by methicillin-resistant Staphylococcus aureus. BMC Res Notes 11:692
Muenks, Carol E; Hogan, Patrick G; Burnham, Carey-Ann D et al. (2018) Comparing the Yield of Staphylococcus aureus Recovery with Static versus Agitated Broth Incubation. J Pathog 2018:1462671
Mork, Ryan L; Hogan, Patrick G; Muenks, Carol E et al. (2018) Comprehensive modeling reveals proximity, seasonality, and hygiene practices as key determinants of MRSA colonization in exposed households. Pediatr Res 84:668-676
McFarland, Michelle; Szasz, Taylor P; Zhou, Julie Y et al. (2017) Colonization with 19F and other pneumococcal conjugate vaccine serotypes in children in St. Louis, Missouri, USA. Vaccine 35:4389-4395
Burnham, C A; Hogan, Patrick G; Wallace, Meghan A et al. (2016) Topical Decolonization Does Not Eradicate the Skin Microbiota of Community-Dwelling or Hospitalized Adults. Antimicrob Agents Chemother 60:7303-7312
Muenks, Carol E; Hogan, Patrick G; Wang, Jeffrey W et al. (2016) Diversity of Staphylococcus aureus strains colonizing various niches of the human body. J Infect 72:698-705
Reich, P J; Boyle, M G; Hogan, P G et al. (2016) Emergence of community-associated methicillin-resistant Staphylococcus aureus strains in the neonatal intensive care unit: an infection prevention and patient safety challenge. Clin Microbiol Infect 22:645.e1-8