Abstract

Recurrent skin and soft tissue infections (SSTI) caused by Community-Associated Methicillin-Resistant Staphylococcus aureus (CA-MRSA) or Methicillin-Sensitive Staphylococcus aureus (CA-MSSA) present treatment challenges. This community-based trial examined the effectiveness of an evidence-based intervention (CDC Guidelines, topical decolonization, surface decontamination) to reduce SSTI recurrence, mitigate household contamination/transmission, and improve patient-reported outcomes. Participants (n = 186) were individuals with confirmed MRSA(+)/MSSA(+) SSTIs and their household members. During home visits; Community Health Workers/Promotoras provided hygiene instructions; a five-day supply of nasal mupirocin; chlorhexidine for body cleansing; and household disinfecting wipes (Experimental; EXP) or Usual Care Control (UC CON) pamphlets. Primary outcome was six-month SSTI recurrence from electronic health records (EHR). Home visits (months 0; 3) and telephone assessments (months 0; 1; 6) collected self-report data. Index patients and participating household members provided surveillance culture swabs. Secondary outcomes included household surface contamination; household member colonization and transmission; quality of life; and satisfaction with care. There were no significant differences in SSTI recurrence between EXP and UC in the intent-to-treat cohort (n = 186) or the enrolled cohort (n = 119). EXP participants showed reduced but non-significant colonization rates. EXP and UC did not differ in household member transmission, contaminated surfaces, or patient-reported outcomes. This intervention did not reduce clinician-reported MRSA/MSSA SSTI recurrence. Taken together with other recent studies that employed more intensive decolonization protocols, it is possible that a promotora-delivered intervention instructing treatment for a longer or repetitive duration may be effective and should be examined by future studies.

Highlights

  • Methicillin-Resistant Staphylococcus aureus (MRSA) causes multi-drug resistant infections that pose serious clinical and public health challenges

  • We evaluated the comparative effectiveness on soft tissue infections (SSTI) recurrence rates and household contamination, household member colonization and transmission, and patient-centered measures using a two-arm 1:1 randomized controlled trial (RCT)

  • No meaningful or statistically significant differences were revealed between the original versus sensitivity analysis results. This trial aimed to understand systems, patient, pathogen, and environmental-level factors associated with SSTI recurrence and household transmission (Figure S2)

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Summary

Introduction

Methicillin-Resistant Staphylococcus aureus (MRSA) causes multi-drug resistant infections that pose serious clinical and public health challenges. Skin and soft tissue infections (SSTIs) [1,2] caused by MRSA carry significant morbidity and mortality, and impact patients, families, caregivers, and health-care institutions [3,4]. While studies comparing protocols for reducing healthcare-associated MRSA (HA-MRSA) infections [5] exist, those adapted for community-associated MRSA (CA-MRSA) SSTIs have provided mixed results [6,7,8,9,10,11]. CA-MRSA SSTIs commonly affect healthy, young individuals without exposure to healthcare risk factors or contacts [12]. (For a list of abbreviations used in this paper see

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