129. Randomized Trial of Routine Hygienic Measures with or without Bleach Baths for Prevention of Recurrent Skin Infections in Children
Session: Oral Abstract Session: Potpourri of Pediatric Infections
Thursday, October 3, 2013: 11:30 AM
Room: The Moscone Center: 250-262
Background: Recurrent infections in normal children caused by community associated S. aureus (CA-SA) occur in up to 50% of patients.   Optimal methods for preventing recurrent infections are unknown.

Methods: Children with probable CA-SA skin and soft (SSI) or invasive infections at Texas Children’s Hospital were randomized to routine daily hygienic measures plus "bleach baths" (5 ml household bleach per gallon of bath water) twice a week (Bleach) or routine daily hygienic measures alone (Control) for 3 mon.  The nose, throat and groin were cultured for SA colonization.  A research nurse blinded to treatment contacted families at 2 weeks and 3, 6, and 12 mon. to ask if the child had had a medically attended SSI (MA-SSI). The study was designed to detect a 50% reduction in first recurrent MA-SSI assuming a 14% recurrence rate, 85% rate of + SA clinical culture at enrollment and 20% loss to follow-up with 90% power. Analysis was based on intention to treat.

Results: SA was isolated from the initial infection site for 890/987 children enrolled; 557/987 were colonized at ≥ 1 site at enrollment. The groin, nose and throat were colonized in 379, 215, and 167 children, respectively. Selected characteristics are shown in the table.

 

Bleach  (n=495)

Control (n=492)

Median Age years (range)

1.8  (.13-18)

1.9 (.26-19)

Site of infection (SSI/Invasive)

466/29

457/35

Isolate  MR/MS

347/104

313/121

Within 12 mon. of enrollment, a MA-SSI occurred in 84/495 (17%) of Bleach vs. 103/492 (20.9%) of Control enrollees (log-rank p=0.15). A multivariable Cox proportional hazards regression model was used to simultaneously estimate the risk of a recurrent MA-SSI  by treatment and age groups. Bleach patients were about 0.79 times less likely to have a reinfection within 1 year; however, the point estimate was not significant at the 0.05 level (95% CI: 0.59, 1.06).

Adjusted for treatment group, the risk of reinfection among patients ≤1.86 years was about 2.1 times> that for patients >1.86 years. The effect of age did not significantly depend on the treatment group (p=0.75).  Reinfection was not different in those colonized.

Conclusion: The groin was the most common site of colonization at initial infection. Younger children were more likely to have recurrent MA-SSI within 1 year of enrollment.  The 20% decrease in MA-SSI recurrences with “Bleach baths” was not statistically significant.

Sheldon Kaplan, MD1, Andrea Forbes, RN1, Wendy Hammerman, RN2, Linda Lamberth, BS2, Kristina G. Hulten, PhD2, Charles Minard, PhD3 and Edward O. Mason, PhD2, (1)Pediatrics, Baylor College of Medicine, Houston, TX, (2)Baylor College of Medicine and Texas Children's Hospital, Houston, TX, (3)Dan L. Duncan Institute for Clinical & Translational Research, Baylor College of Medicine, Houston, TX

Disclosures:

S. Kaplan, None

A. Forbes, None

W. Hammerman, None

L. Lamberth, None

K. G. Hulten, None

C. Minard, None

E. O. Mason, None

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