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)
Summary
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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