393. Feasibility of a Randomized-Controlled Trial for a Comprehensive Decolonization Strategy among Patients with Carriage of Community-associated Methicillin-Resistant Staphylococcus aureus in the Outpatient Setting
Session: Poster Abstract Session: MRSA, MSSA, Enterococci
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Background: There is limited data on the efficacy of decolonization in reducing methicillin-resistant Staphylococcus aureus (MRSA) carriage and infection in the outpatient setting where community-associated MRSA (CA-MRSA) strains predominate. The objective of this study was to examine the feasibility of administering a comprehensive decolonization treatment to patients seen in our MRSA Decolonization Clinic. 

Methods: Patients (≥ 18 years) with a history of MRSA infection or colonization and positive MRSA carriage on multi-site rescreening were randomized to receive treatment [intranasal 2% mupirocin, fusidic acid, or 2% chlorhexidine gluconate (CHG) twice daily and 4% CHG body scrub/shampoo daily with oral trimethoprim/sulfamethoxazole or doxycycline for 7 days] or no treatment. Clinical assessment and screening cultures were done on nasal and extranasal sites at end of therapy, 1 month and 3 months. The primary outcome was detection of MRSA at 3 months. Occurrence of MRSA infection was assessed at 6 months. Clinic patients eligible for inclusion but who declined enrollment were also followed. Molecular analyses were performed on all MRSA isolates using multi-locus sequence typing, spa and SCCmec typing.

Results: Of 205 screened clinic patients, 15 (7%) met the inclusion criteria and agreed to be randomized into the study (9 in treatment and 6 in control).  At 3 months, 4/8 (50%) in the treatment group had eradication and none in the control group (0/4, 0%)). Infection occurred in 5 patients (3 in treatment and 2 in control). Among 12 non-randomized patients with follow-up at 3 months, the rate of eradication did not differ between those who received treatment and those who did not (4/9, 44% vs. 2/3, 66%). The majority of MRSA isolates (33/34) were CA-MRSA strain type with USA300 accounting for 82%. There was good compliance to the decolonization regimen without any significant adverse events.

Conclusion: Among persistent CA-MRSA carriers, our comprehensive decolonization treatment was well tolerated and adherence was high. However, enrollment was limited due to non-carriage on repeat screening, inconvenience of multiple follow-ups, and limited clinic capacity. Future studies with different enrollment strategies, larger participant screening and incentives may be required to allow a successful trial.

Joseph Kim, MD, Kunyan Zhang, MD, PhD, John Conly, MD, Thomas Louie, MD, Reg Sauve, MD and Elizabeth Henderson, PhD, University of Calgary, Calgary, AB, Canada


J. Kim, None

K. Zhang, None

J. Conly, None

T. Louie, None

R. Sauve, None

E. Henderson, None

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