352. Randomized, Double-Blinded Study on Decolonization Procedures for Methicillin-Resistant Staphylococcus aureus (MRSA) among HIV-infected Adults
Session: Poster Abstract Session: MRSA, MSSA, Enterococci
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • IDCRP_MRSA Poster IDSA.pdf (194.2 kB)
  • Background: HIV-infected persons have markedly increased risk for both MRSA colonization and skin and soft-tissue infections (SSTIs).  However, no clinical trials have examined the utility of decolonization procedures in reducing colonization or infection among HIV-infected, non-intravenous drug users.

    Methods: 550 HIV-infected adults at four geographically diverse US military HIV clinics were prospectively screened for MRSA carriage (nares, pharynx, axilla, groin, and perirectal) every 6 months over a 2-year period. Those colonized were randomized to decolonization procedures with application of hexachlorophene (pHisoHex®) soaps daily and nasal mupirocin (Bactroban®) twice daily for 7 days compared to a placebo soap and nasal ointment similar in appearance but with no antibacterial activity.  The primary endpoint was colonization at the 6-month visit; secondary endpoints were time to clearance using monthly swab data, and an SSTI or MRSA infection event.  The sample size of 550 HIV patients was based on estimated differences in post-treatment clearance rates at the six-month time-point and a power of 80%.  Statistical analyses included multivariate logistic regression and Cox proportional hazards models.

    Results:  Forty-nine (9%) HIV-infected persons were MRSA colonized during the study period and randomized.  Among those with 6-month swab data (80% of those randomized), 67% were negative for MRSA colonization in both treatment groups (p=1.0).  Analyses accounting for missing 6-month data showed no significant differences between groups could have been achieved.  In the multivariate adjusted models, randomization group was not associated with 6-month MRSA clearance; predictors of clearance included higher CD4 counts and younger age.  The median time to MRSA clearance was similar in the treatment vs. placebo groups (1.2 vs. 1.7 months, p=0.62).  There was no difference by treatment group on the subsequent development of SSTI or MRSA infections (6 in placebo and 4 in treatment group, p=0.53).

    Conclusion: Decolonization procedures had no significant effect on follow-up MRSA colonization or infection rates among HIV-infected persons, hence may not provide an effective strategy to reduce the burden of MRSA in this population.

    Amy Weintrob, MD1,2, Ionut Bebu, PhD3, Erica Johnson, MD2,4, Tahaniyat Lalani, MD2,5, Alona Diem2, Brian Agan, MD2 and Nancy Crum-Cianflone, MD MPH2,6, (1)Walter Reed National Military Medical Center, Bethesda, MD, (2)Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, (3)Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, MD, (4)San Antonio Military Med. Ctr., San Antonio, TX, (5)Naval Medical Center, Portsmouth, VA, (6)Naval Medical Center San Diego, San Diego, CA

    Disclosures:

    A. Weintrob, None

    I. Bebu, None

    E. Johnson, None

    T. Lalani, None

    A. Diem, None

    B. Agan, None

    N. Crum-Cianflone, None

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