Staphylococcus aureus is a ubiquitous pathogen, and causes infections of the skin, bloodstream, lung, and other body sites. Community-acquired methicillin resistant S. aureus (CA-MRSA) infections, which were previously extremely rare, are now occurring commonly worldwide. CA-MRSA is the most common cause of skin infection in many locales in the U.S., including Southern California. CA-MRSA strains are notable for their ability to spread in closed settings and cause recurrent infections among healthy persons. Management of recurrent CA-MRSA infection is challenging and optimal prevention strategies are undefined. Many experts recommend topical agents that decontaminate the body and/or anterior nares. Others suggest environmental decontamination to help control recurrences and transmission within households. However, there are no data that quantify the efficacy and safety of these approaches. We will conduct a multi-center clinical trial to compare the efficacy and safety of body and environmental decolonization regimens in the prevention of CA-MRSA infection. The study population will comprise of persons suffering from recurrent CA-MRSA infection. This investigation will partner investigators with extensive experience studying CA-MRSA infection with investigators from Kaiser Permanente Southern California, a large Health Maintenance Organization that is a leader in the use of electronic medical records. For this clinical trial, all subjects will be randomized in a 2 x 2 design to test: 1) chlorhexidine body washes plus nasal mupirocin ointment vs. usual care, and 2) environmental cleansing with ethanol spray and aggressive laundering vs. no environmental cleansing. We will also conduct complementary investigations, including studying the interventions' efficacy at preventing infections in household members, modeling oredictors of recurrent CA-MRSA infection, and measuring pharmaco-economic outcomes. We will also examine strain relatedness of colonizing and infecting CA-MRSA strains to better understand colonization dynamics within households. Our clinical trial will forward our understanding of the benefit of decolonization regimens at preventing A-MRSA infection. Additionally, our studies will advance our understanding of the pathogenesis and scope of recurrent CA-MRSA infection. ? ? ?

Agency
National Institute of Health (NIH)
Institute
National Center for Infectious Diseases (CID)
Type
Research Project--Cooperative Agreements (U01)
Project #
1U01CI000384-01
Application #
7219310
Study Section
Special Emphasis Panel (ZCD1-EEO (06))
Program Officer
Messmer, Trudy
Project Start
2006-09-30
Project End
2009-09-29
Budget Start
2006-09-30
Budget End
2007-09-29
Support Year
1
Fiscal Year
2006
Total Cost
$299,999
Indirect Cost
Name
La Biomed Research Institute/ Harbor UCLA Medical Center
Department
Type
DUNS #
069926962
City
Torrance
State
CA
Country
United States
Zip Code
90502
Daum, Robert S; Spellberg, Brad (2012) Progress toward a Staphylococcus aureus vaccine. Clin Infect Dis 54:560-7
Mozzillo, K L; Ortiz, N; Miller, L G (2010) Patients with methicillin-resistant Staphylococcus aureus infection: twenty-first century lepers. J Hosp Infect 75:132-4
Chira, S; Miller, L G (2010) Staphylococcus aureus is the most common identified cause of cellulitis: a systematic review. Epidemiol Infect 138:313-7
Montgomery, Christopher P; Boyle-Vavra, Susan; Daum, Robert S (2009) The arginine catabolic mobile element is not associated with enhanced virulence in experimental invasive disease caused by the community-associated methicillin-resistant Staphylococcus aureus USA300 genetic background. Infect Immun 77:2650-6
Montgomery, Christopher P; Daum, Robert S (2009) Transcription of inflammatory genes in the lung after infection with community-associated methicillin-resistant Staphylococcus aureus: a role for panton-valentine leukocidin? Infect Immun 77:2159-67
Daum, Robert S (2009) Epidemic community-associated methicillin-resistant Staphylococcus aureus infections--increasingly, everyone's problem. J AAPOS 13:225-6
Miller, Loren G; Diep, Binh An (2008) Clinical practice: colonization, fomites, and virulence: rethinking the pathogenesis of community-associated methicillin-resistant Staphylococcus aureus infection. Clin Infect Dis 46:752-60
David, Michael Z; Rudolph, Karen M; Hennessy, Thomas W et al. (2008) Molecular epidemiology of methicillin-resistant Staphylococcus aureus, rural southwestern Alaska. Emerg Infect Dis 14:1693-9
Montgomery, Christopher P; Boyle-Vavra, Susan; Adem, Patricia V et al. (2008) Comparison of virulence in community-associated methicillin-resistant Staphylococcus aureus pulsotypes USA300 and USA400 in a rat model of pneumonia. J Infect Dis 198:561-70
David, Michael Z; Glikman, Daniel; Crawford, Susan E et al. (2008) What is community-associated methicillin-resistant Staphylococcus aureus? J Infect Dis 197:1235-43

Showing the most recent 10 out of 11 publications