Targeted intranasal mupirocin to prevent colonization and infection by community-associated methicillin-resistant Staphylococcus aureus strains in soldiers: a cluster randomized controlled trial.
نویسندگان
چکیده
Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is an emerging pathogen that primarily manifests as uncomplicated skin and soft tissue infections. We conducted a cluster randomized, double-blind, placebo-controlled trial to determine whether targeted intranasal mupirocin therapy in CA-MRSA-colonized soldiers could prevent infection in the treated individual and prevent new colonization and infection within their study groups. We screened 3,447 soldiers comprising 14 training classes for CA-MRSA colonization from January to December 2005. Each training class was randomized to either the mupirocin or placebo study group, and the participants identified as CA-MRSA colonized were treated with either mupirocin or placebo. All participants underwent repeat screening after 8 to 10 weeks and were monitored for 16 weeks for development of infection. Of 3,447 participants screened, 134 (3.9%) were initially colonized with CA-MRSA. Five of 65 (7.7%; 95% confidence interval [95% CI], 4.0% to 11.4%) placebo-treated participants and 7 of 66 (10.6%; 95% CI, 7.9% to 13.3%) mupirocin-treated participants developed infections; the difference in the infection rate of the placebo- and mupirocin-treated groups was -2.9% (95% CI, -7.5% to 1.7%). Of those not initially colonized with CA-MRSA, 63 of 1,459 (4.3%; 95% CI, 2.7% to 5.9%) of the placebo group and 56 of 1,607 (3.5%; 95% CI, 2.6% to 5.2%) of the mupirocin group developed infections; the difference in the infection rate of the placebo and mupirocin groups was 0.8% (95% CI, -1.0% to 2.7%). Of 3,447 participants, 3,066 (89%) were available for the second sampling and completed follow-up. New CA-MRSA colonization occurred in 24 of 1,459 (1.6%; 95% CI, 0.05% to 2.8%) of the placebo group participants and 23 of 1,607 (1.4%; 95% CI, 0.05% to 2.3%) of the mupirocin group participants; the difference in the infection rate of the placebo and mupirocin groups was 0.2% (95% CI, -1.3% to 1.7%). Despite CA-MRSA eradication in colonized participants, this study showed no decrease in infections in either the mupirocin-treated individuals or within their study group. Furthermore, CA-MRSA eradication did not prevent new colonization within the study group.
منابع مشابه
Risk Factors of Nasal Carriage of Methicillin-Resistant Staphylococcus Aureus and its Antibiotic Susceptibility Pattern in Namazi hospital Healthcare Workers in Shiraz, Iran
Background & Aims: Methicillin-resistant Staphylococcus aureus (MRSA) is a major nosocomial pathogen worldwide. The aim of this study was to determine the risk factors of nasal carriage of MRSA and its antibiotic susceptibility pattern among healthcare workers at Namazi Hospital (Shiraz-Iran) Methods: In a cross-sectional study from July to November 2006, nasal swabs were taken from 600 stratif...
متن کاملRandomized Controlled Trial of Chlorhexidine Gluconate for Washing, Intranasal Mupirocin, plus Rifampin and Doxycycline versus No Treatment for the Eradication of Methicillin-Resistant Staphylococcus aureus (MRSA) Colonization
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Nasal Colonization Rate of Community and Hospital Acquired Methicillin Resistant Staphylococcus Aureus in Hospitalized Children
Background & Aims: Prevalence of community and hospital acquired methicillin-resistant Staphylococcus aureus (MRSA) infection is increasing. The primary reservoir is the anterior nares; and nasal carriage is a risk factor for infection in a variety of populations. Infection due to hospital-acquired colonization is different from community acquired in clinical manifestations and antibiotics susc...
متن کاملRandomized controlled trial of chlorhexidine gluconate for washing, intranasal mupirocin, and rifampin and doxycycline versus no treatment for the eradication of methicillin-resistant Staphylococcus aureus colonization.
BACKGROUND Eradication of methicillin-resistant Staphylococcus aureus (MRSA) carriage may reduce the risk of MRSA infection and prevent transmission of the organism to other patients. METHODS To determine the efficacy of decolonization therapy, patients colonized with MRSA were randomized (3:1 allocation) to receive treatment (2% chlorhexidine gluconate washes and 2% mupirocin ointment intran...
متن کاملTreatment of Staphylococcus aureus colonization in atopic dermatitis decreases disease severity.
OBJECTIVES The goals were to determine the prevalence of community-acquired methicillin-resistant Staphylococcus aureus colonization in patients with atopic dermatitis and to determine whether suppression of S aureus growth with sodium hypochlorite (bleach) baths and intranasal mupirocin treatment improves eczema severity. METHODS A randomized, investigator-blinded, placebo-controlled study w...
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ورودعنوان ژورنال:
- Antimicrobial agents and chemotherapy
دوره 51 10 شماره
صفحات -
تاریخ انتشار 2007