Treatments After Hospital Discharge Prevent MRSA Infections

A new AHRQ-funded study shows that methicillin-resistant Staphylococcus aureus (MRSA) infections and hospitalizations after hospital discharge dropped by 30 percent in patients known to carry the bacteria on their bodies by a treatment that cleansed the bacteria from their skin or in their noses. The study in the New England Journal of Medicine included more than 2,000 patients with MRSA discharged from Southern California hospitals between 2011 and 2014. One group in the study received educational materials while a second group received the same educational materials plus took steps over six months to remove MRSA from their skin and noses with chlorhexidine antiseptic for bathing, chlorhexidine mouthwash and the nasal antibiotic ointment mupirocin. Participants who followed the treatment completely had a 44 percent reduction in MRSA infections and a 40 percent reduction in all infections. Access the article abstract and the AHRQ news release.

2019 Feb 14;380(7):638-650. doi: 10.1056/NEJMoa1716771.

Decolonization to Reduce Postdischarge Infection Risk among MRSA Carriers.

Huang SS1, Singh R1, McKinnell JA1, Park S1, Gombosev A1, Eells SJ1, Gillen DL1, Kim D1, Rashid S1, Macias-Gil R1, Bolaris MA1, Tjoa T1, Cao C1, Hong SS1, Lequieu J1, Cui E1, Chang J1, He J1, Evans K1, Peterson E1, Simpson G1, Robinson P1, Choi C1, Bailey CC Jr1, Leo JD1, Amin A1, Goldmann D1, Jernigan JA1, Platt R1, Septimus E1, Weinstein RA1, Hayden MK1, Miller LG1; Project CLEAR Trial.

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Abstract

BACKGROUND:

Hospitalized patients who are colonized with methicillin-resistant Staphylococcus aureus (MRSA) are at high risk for infection after discharge.

METHODS:

We conducted a multicenter, randomized, controlled trial of postdischarge hygiene education, as compared with education plus decolonization, in patients colonized with MRSA (carriers). Decolonization involved chlorhexidine mouthwash, baths or showers with chlorhexidine, and nasal mupirocin for 5 days twice per month for 6 months. Participants were followed for 1 year. The primary outcome was MRSA infection as defined according to Centers for Disease Control and Prevention (CDC) criteria. Secondary outcomes included MRSA infection determined on the basis of clinical judgment, infection from any cause, and infection-related hospitalization. All analyses were performed with the use of proportional-hazards models in the per-protocol population (all participants who underwent randomization, met the inclusion criteria, and survived beyond the recruitment hospitalization) and as-treated population (participants stratified according to adherence).

RESULTS:

In the per-protocol population, MRSA infection occurred in 98 of 1063 participants (9.2%) in the education group and in 67 of 1058 (6.3%) in the decolonization group; 84.8% of the MRSA infections led to hospitalization. Infection from any cause occurred in 23.7% of the participants in the education group and 19.6% of those in the decolonization group; 85.8% of the infections led to hospitalization. The hazard of MRSA infection was significantly lower in the decolonization group than in the education group (hazard ratio, 0.70; 95% confidence interval [CI], 0.52 to 0.96; P=0.03; number needed to treat to prevent one infection, 30; 95% CI, 18 to 230); this lower hazard led to a lower risk of hospitalization due to MRSA infection (hazard ratio, 0.71; 95% CI, 0.51 to 0.99). The decolonization group had lower likelihoods of clinically judged infection from any cause (hazard ratio, 0.83; 95% CI, 0.70 to 0.99) and infection-related hospitalization (hazard ratio, 0.76; 95% CI, 0.62 to 0.93); treatment effects for secondary outcomes should be interpreted with caution owing to a lack of prespecified adjustment for multiple comparisons. In as-treated analyses, participants in the decolonization group who adhered fully to the regimen had 44% fewer MRSA infections than the education group (hazard ratio, 0.56; 95% CI, 0.36 to 0.86) and had 40% fewer infections from any cause (hazard ratio, 0.60; 95% CI, 0.46 to 0.78). Side effects (all mild) occurred in 4.2% of the participants.

CONCLUSIONS:

Postdischarge MRSA decolonization with chlorhexidine and mupirocin led to a 30% lower risk of MRSA infection than education alone. (Funded by the AHRQ Healthcare-Associated Infections Program and others; ClinicalTrials.gov number, NCT01209234 .).