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Project CLEAR: Serial decolonization reduces MRSA infection after hospital discharge
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NEW ORLEANS — Decolonization with mupirocin and chlorhexidine reduced both MRSA and all-cause infection over a 1-year period in MRSA carriers who were recently discharged from a hospital, according to the results of a randomized controlled trial.
Susan S. Huang, MD, MPH, professor of infectious disease and medical director of epidemiology and infection prevention at the University of California, Irvine, School of Medicine, delivered results from Project CLEAR, or Changing Lives by Eradicating Antibiotic Resistance, which explored strategies to prevent MRSA infection in colonized patients after hospital discharge.
“Patients who have MRSA who are discharged after hospitalization have a 24% risk of a serious infection in the next year after discharge, and 9% of them will develop serious MRSA disease,” Huang told Infectious Disease News at IDWeek 2016. “We showed that a simple serial decolonization intervention over a period of 6 months reduced that risk of MRSA disease by 30% and a risk of all-cause infection by almost 20%.”
Between January 2011 and June 2014, Huang and colleagues enrolled more than 2,100 adult patients in Southern California who had been hospitalized within the past 30 days and who had a known MRSA-positive culture within 30 days of hospitalization. They excluded patients in active hospice, those without running water, and any patient with a known allergy to decolonization products.
They randomly assigned the patients to receive either hygienic education (n = 1,063) or hygienic education plus serial decolonization (n = 1,058) and followed them for 1 year.
Serial decolonization lasted 6-months, consisting of twice-daily nasal mupirocin, twice-daily chlorhexidine mouthwash, and rinsing daily with 4% chlorhexidine in a shower or bath.
During the trial, Hang and colleagues made monthly calls to each patient to ask them if they had any further hospitalizations or out-patient visits related to infection, and called participants in the decolonization arm once a month to remind them of the procedure. At enrollment, and then again after 1, 3, 6 and 9 months, Huang and colleagues conducted surveys of all participants and collected nose, throat, skin and wound swabs from each patient. At 12 months, they conducted phone exit surveys.
They found that topical decolonization with mupirocin and chlorohexidine led to a 30% reduction in MRSA infection and a 16% reduction in all-cause infection in the 1-year period following discharge. Further, patients who were fully adherent to the 6-month decolonization protocol saw a 44% reduction in MRSA infection and a 40% reduction in all-cause infection.
Huang and colleagues noted that 60% of all invasive MRSA disease in MRSA-positive patients occurs after they are discharged from the hospital.
“We know the risk of infection is quite strong for MRSA carriers for subsequent MRSA and other types of diseases, and that’s probably because we fail to have functional immunity to [Staphylococcus] aureus,” Huang said during a presentation here. “So, prolonged colonization continues to present a risk for infection. And while we’ve made great strides in hospital settings to reduce infection, we really have not been able to tackle the large amount of infections that occur in the post-discharge setting.” – by Gerard Gallagher
Reference:
Huang SS, et al. Abstract 1745. Presented at: IDWeek; Oct. 26-30, 2016; New Orleans.
Disclosures: Huang reports that health care facilities participating in her studies received products for decolonization that were contributed by industry. Please see the full study for a list of all other authors’ relevant financial disclosures.