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

Disclosures:

J. Kim, None

K. Zhang, None

J. Conly, None

T. Louie, None

R. Sauve, None

E. Henderson, None

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