301. Randomized Double-Blinded Placebo-Controlled Trial to Assess the Effect of Retapamulin for Nasal Decolonization of Mupirocin-Resistant Methicillin-Resistant Staphylococcus aureus (Mup-R MRSA) Nasal Carriers
Session: Poster Abstract Session: HAI: MSSA, MRSA, and other Gram-Positives
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • Retapamulin IDWeek Poster 2016 v8.pdf (211.5 kB)
  • Background:

    Mupirocin is commonly used for nasal clearance of MRSA in carriers during high risk situations such as pre-operatively, during ICU stays, and to prevent recurrent disease. Low level (LL) and high level (HL) mupirocin resistance have been reported and may warrant evaluation of alternative therapies.

    Methods:

    We conducted a double blinded RCT of retapamulin vs. placebo for patients with confirmed nasal Mup-R MRSA. Subjects were identified from MRSA samples tested for Mup-R from the UC Irvine Medical Center microbiology lab and from samples from participants who completed a separate clinical trial (Project CLEAR) from Sept 2012-Aug 2015. Randomization was stratified by LL vs HL Mup-R. Subjects used a 5-day twice daily course of assigned product (D1-5) followed by nasal sampling one week later (D12). If still positive, subjects were given another 5-day course of the assigned product. Primary outcome was MRSA nasal carriage at 6 weeks following the initial course (D47). Secondary outcome was MRSA nasal carriage at D12. Unadjusted trial results were based upon Fisher’s Exact Tests. Adjusted results used logistic regression models that selected from a priori variables (recent hospitalization, recent ICU stay, bathing frequency, skin infection, steroid use and college education) to minimize Akaike’s Information Criterion.

    Results:

    4,394 MRSA isolates were screened to find 294 (6.7%) patients with Mup-R isolates. Of these, 95 were contacted and 53 were randomized (Table 1). Three dropped out prior to any follow up visit, leaving 25 subjects per group to complete both visits with high adherence. Reduction in MRSA nasal carriage was found at Day 12, but not Day 47 (Table 2). Case counts by HL and LL Mup-R are found in Table 3. No change in estimated effects was seen in adjusted models. No adverse events were reported.

    Conclusion:

    This randomized controlled trial found that nasal retapamulin significantly reduced Mup-R nasal MRSA 1 week following a 5-day application, but reductions were not sustained at 6 weeks. Retapamulin may be a viable alternative to mupirocin for temporary risk periods such as surgery and ICU stays, but long-lived benefit may require alternative agents or longer therapeutic duration.

     

    Raveena Singh, MA1, Adrijana Gombosev, MS1, Tabitha Dutciuc, MPH1, Kaye Evans, BA2, Lena M Portillo, BS, MT(ASCP)3, Mary K Hayden, MD3, Daniel Gillen, PhD4, Ellena Peterson, PhD2, Thomas Tjoa, MPH, MS1, Chenghua Cao, MPH1, Eric Cui, BS1, Claudia Cervantes, BA1, Justin Chang, BS1, Brian Lewis, BS1, Diane Kim, BS1, Loren Miller, MD, MPH5 and Susan S. Huang, MD, MPH, FIDSA, FSHEA1, (1)Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, CA, (2)Department of Pathology and Laboratory Medicine, University of California Irvine School of Medicine, Orange, CA, (3)Division of Infectious Diseases, Rush University School of Medicine, Chicago, IL, (4)Department of Statistics, University of California Irvine, Irvine, CA, (5)Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, CA

    Disclosures:

    R. Singh, Sage Products: Conducting studies in healthcare facilities that are receiving contributed product , Conducting studies in healthcare facilities that are receiving contributed product
    3M: Conducting studies in healthcare facilities that are receiving contributed product , Conducting studies in healthcare facilities that are receiving contributed product
    Clorox: Conducting studies in healthcare facilities that are receiving contributed product , Conducting studies in healthcare facilities that are receiving contributed product

    A. Gombosev, Sage Products: Conducting studies in healthcare facilities that are receiving contributed product , Conducting studies in healthcare facilities that are receiving contributed product
    Molnlycke: Conducting studies in healthcare facilities that are receiving contributed product , Conducting studies in healthcare facilities that are receiving contributed product
    3M: Conducting studies in healthcare facilities that are receiving contributed product , Conducting studies in healthcare facilities that are receiving contributed product
    Clorox: Conducting studies in healthcare facilities that are receiving contributed product , Conducting studies in healthcare facilities that are receiving contributed product

    T. Dutciuc, Sage Products: Conducting studies in healthcare facilities that are receiving contributed product , Conducting studies in healthcare facilities that are receiving contributed product
    3M: Conducting studies in healthcare facilities that are receiving contributed product , Conducting studies in healthcare facilities that are receiving contributed product
    Clorox: Conducting studies in healthcare facilities that are receiving contributed product , Conducting studies in healthcare facilities that are receiving contributed product

    K. Evans, None

    L. M. Portillo, None

    M. K. Hayden, Sage Products: Conducting studies in healthcare facilities that are receiving contributed product , Conducting studies in healthcare facilities that are receiving contributed product
    Molnlycke: Conducting studies in healthcare facilities that are receiving contributed product , Conducting studies in healthcare facilities that are receiving contributed product

    D. Gillen, None

    E. Peterson, None

    T. Tjoa, None

    C. Cao, None

    E. Cui, None

    C. Cervantes, None

    J. Chang, None

    B. Lewis, None

    D. Kim, Sage Products: Conducting studies in healthcare facilities that are receiving contributed product , Conducting studies in healthcare facilities that are receiving contributed product
    3M: Conducting studies in healthcare facilities that are receiving contributed product , Conducting studies in healthcare facilities that are receiving contributed product
    Clorox: Conducting studies in healthcare facilities that are receiving contributed product , Conducting studies in healthcare facilities that are receiving contributed product

    L. Miller, Sage Products: Conducting studies in healthcare facilities that are receiving contributed product , Conducting studies in healthcare facilities that are receiving contributed product
    3M: Conducting studies in healthcare facilities that are receiving contributed product , Conducting studies in healthcare facilities that are receiving contributed product
    Clorox: Conducting studies in healthcare facilities that are receiving contributed product , Conducting studies in healthcare facilities that are receiving contributed product

    S. S. Huang, Sage Products: Conducting studies in which participating healthcare facilities are receiving contributed product (no contribution in submitted abstract) , Participating healthcare facilities in my studies received contributed product
    Molnlycke: Conducting studies in which participating healthcare facilities are receiving contributed product (no contribution in submitted abstract) , Participating healthcare facilities in my studies received contributed product
    3M: Conducting studies in which participating healthcare facilities are receiving contributed product (no contribution in submitted abstract) , Participating healthcare facilities in my studies received contributed product
    Clorox: Conducting studies in which participating healthcare facilities are receiving contributed product (no contribution in submitted abstract) , Participating healthcare facilities in my studies received contributed product

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.