TY - JOUR
T1 - Comparative effectiveness study of home-based interventions to prevent CA-MRSA infection recurrence
AU - Tobin, Jonathan N.
AU - Hower, Suzanne
AU - D’Orazio, Brianna M.
AU - de la Gándara, María Pardos
AU - Evering, Teresa H.
AU - Khalida, Chamanara
AU - Ramachandran, Jessica
AU - González, Leidy Johana
AU - Kost, Rhonda G.
AU - Vasquez, Kimberly S.
AU - de Lencastre, Hermínia
AU - Tomasz, Alexander
AU - Coller, Barry S.
AU - Vaughan, Roger
N1 - Funding Information:
Funding: The trial was funded by Patient-Centered Outcomes Research Institute (PCORI) Contract Number CER-1402-10800. PCORI scientific staff played no role in study design and conduct.
Publisher Copyright:
© 2021 by the authors. Licensee MDPI, Basel, Switzerland.
PY - 2021/9
Y1 - 2021/9
N2 - Recurrent skin and soft tissue infections (SSTI) caused by Community-Associated Methi-cillin-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-re-ported 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) pam-phlets. 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.
AB - Recurrent skin and soft tissue infections (SSTI) caused by Community-Associated Methi-cillin-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-re-ported 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) pam-phlets. 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.
KW - Antibiotic-resistance
KW - Community-based participatory research (CBPR)
KW - Methicillin-resistant Staphylococcus aureus (MRSA)
KW - Practice-based research network (PBRN)
KW - Randomized clinical trial (RCT)
KW - Skin and soft tissue infection (SSTI)
UR - http://www.scopus.com/inward/record.url?scp=85115128933&partnerID=8YFLogxK
U2 - 10.3390/antibiotics10091105
DO - 10.3390/antibiotics10091105
M3 - Article
AN - SCOPUS:85115128933
SN - 2079-6382
VL - 10
JO - Antibiotics
JF - Antibiotics
IS - 9
M1 - 1105
ER -
