Comparative Effectiveness Study of Home-Based Interventions to Prevent CA-MRSA Infection Recurrence.
Jonathan N TobinSuzanne HowerBrianna M D'OrazioMaria Pardos de la GandaraTeresa H EveringChamanara KhalidaJessica RamachandranLeidy Johana GonzálezRhonda G KostKimberly S VasquezHermínia de LencastreAlexander TomaszBarry S CollerRoger VaughanPublished in: Antibiotics (Basel, Switzerland) (2021)
Recurrent skin and soft tissue infections (SSTI) caused by Community-Associated Methicillin-Resistant Staphylococcus aureus (CA-MRSA) or Methicillin-Sensitive Staphylococcus aureus (CA-MSSA) present treatment challenges. This community-based trial examined the effectiveness of an evidence-based intervention (CDC Guidelines, topical decolonization, surface decontamination) to reduce SSTI recurrence, mitigate household contamination/transmission, and improve patient-reported outcomes. Participants (n = 186) were individuals with confirmed MRSA(+)/MSSA(+) SSTIs and their household members. During home visits; Community Health Workers/Promotoras provided hygiene instructions; a five-day supply of nasal mupirocin; chlorhexidine for body cleansing; and household disinfecting wipes (Experimental; EXP) or Usual Care Control (UC CON) pamphlets. Primary outcome was six-month SSTI recurrence from electronic health records (EHR). Home visits (months 0; 3) and telephone assessments (months 0; 1; 6) collected self-report data. Index patients and participating household members provided surveillance culture swabs. Secondary outcomes included household surface contamination; household member colonization and transmission; quality of life; and satisfaction with care. There were no significant differences in SSTI recurrence between EXP and UC in the intent-to-treat cohort (n = 186) or the enrolled cohort (n = 119). EXP participants showed reduced but non-significant colonization rates. EXP and UC did not differ in household member transmission, contaminated surfaces, or patient-reported outcomes. This intervention did not reduce clinician-reported MRSA/MSSA SSTI recurrence. Taken together with other recent studies that employed more intensive decolonization protocols, it is possible that a promotora-delivered intervention instructing treatment for a longer or repetitive duration may be effective and should be examined by future studies.
Keyphrases
- methicillin resistant staphylococcus aureus
- staphylococcus aureus
- patient reported outcomes
- electronic health record
- randomized controlled trial
- healthcare
- biofilm formation
- free survival
- soft tissue
- risk assessment
- drinking water
- palliative care
- end stage renal disease
- ejection fraction
- chronic kidney disease
- type diabetes
- clinical trial
- physical activity
- public health
- adipose tissue
- health risk
- study protocol
- skeletal muscle
- climate change
- metabolic syndrome
- clinical practice
- machine learning
- escherichia coli
- clinical decision support
- glycemic control