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Clearance of MRSA colonization occurs earlier than previously described
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The duration of MRSA colonization after a skin and soft tissue infection was shorter than previously reported, according to data from a recent study.
“Increased age was associated with longer duration of MRSA colonization in index cases,” the researchers wrote in Clinical Infectious Diseases. “Clindamycin treatment of MRSA [skin and soft tissue infection (SSTI)], on the other hand, was associated with earlier clearance of colonization. There was also a borderline significant association between increased numbers of household members colonized with MRSA and longer duration of colonization.”
Valerie C. Cluzet, MD, of the Perelman School of Medicine at the University of Pennsylvania, and colleagues conducted a prospective cohort study of patients who presented with MRSA SSTI from January 2010 through December 2012. The cases and their household members performed self-sampling from three sites — nares, groin and axillae — every 2 weeks for 6 months. The swabs were evaluated for MRSA and isolates underwent susceptibility testing.
The study included 243 index cases and 803 household members. The median duration of colonization among the patients was 21 days, and at the end of the study, 19.8% of patients remained colonized. In a multivariable analysis, clindamycin treatment within 14 days after diagnosis was linked to early clearance in the index case (HR = 1.7; 95% CI, 1.27-1.3). Older age was associated with longer duration of colonization (HR = 0.99; 95% CI, 0.98-1). Longer colonization also was borderline associated with an increased number of household members with colonization (HR = 0.85; 95% CI, 0.71-1.01).
“Future studies should examine the predictors of persistent colonization, the impact of prolonged duration of colonization on development of MRSA reinfection and the potential role of total household decolonization in adults and children,” the researchers wrote. “In addition, the unique role of clindamycin in treatment of MRSA infections should be further elucidated.”
In an accompanying editorial, Michael S. Calderwood, MD, MPH, of the division of infectious diseases at Brigham and Women’s Hospital in Boston, said the duration of MRSA colonization is an unresolved issue.
Michael S. Calderwood
“Overall, [the researchers] have presented stimulating results from a well-designed study which took great efforts to longitudinally follow the MRSA colonization status of a cohort of patients and their household members following diagnosis of community-acquired MRSA SSTI,” Calderwood wrote. “Both the shorter duration of time to clearance of MRSA colonization and the putative association between SSTI treatment with clindamycin and a shorter duration of MRSA colonization deserve further investigation.”
Disclosure: Cluzet and Calderwood report no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
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