Household MRSA Controlled Through Treatment Compliance, Patient Education

July 28, 2016

A new study found that following basic hygienic practices and complying with protocols for methicillin-resistant Staphylococcus aureus (MRSA) decolonization reduces the time to clearance of the bacteria more quickly than a treatment regimen of antibiotic ointment and antiseptic body wash. The findings, published today in Infection Control & Hospital Epidemiology, demonstrate the importance of educating patients in hygienic practices, in addition to encouraging adherence to decolonization protocols in the treatment of MRSA.

"MRSA is particularly dangerous because it can colonize in others without causing infection; and those in close contact, such as family members, are more likely to transmit MRSA to each other," said Valerie Cluzet, MD, an instructor in the division of Infectious Diseases at the Perelman School of Medicine at the University of Pennsylvania, and lead author of the study. "As a result, household members could be an ongoing source of MRSA, leading to recurring infections."

The three-arm non-blinded randomized control trial was conducted at five academic medical centers in southeastern Pennsylvania among members of 223 households. It compared three different interventions: education on personal and household hygiene; education with treatment and reminders with daily phone calls and text messages; and education with treatment, but no reminders.

Researchers observed no significant difference in time to clearance of MRSA between the group that received only education and the groups of patients that received antibiotic treatment. However, secondary analyses found that the biggest impact on decolonization was compliance to treatment (>100%). When patients followed the antibiotic treatment guidance, the bacteria were cleared more quickly (23 days) compared with non-compliant households (27 days).

Based on these findings, the researchers recommend clinicians emphasize to patients the importance of compliance with decolonization treatment for successfully clearing MRSA, and spend time educating patients with MRSA about its transmission and measures to control it. Practices such as washing linens regularly, wiping down high-touch surfaces, avoiding sharing personal hygiene items, and practicing hand hygiene can reduce household spread.

"We believe that our study leads to other crucial questions that deserve attention, such as the role of other parts of the household, including pets and the environment, in MRSA transmission, the importance of compliance with decolonization protocols, and the optimal timing, duration, and frequency of decolonization," said Cluzet.

Reference: Valerie Cluzet, Jeffrey Gerber, Joshua Metlay, Irving Nachamkin, Theoklis Zaoutis, Meghan Davis, Kathleen Julian, Darren Linkin, Susan Coffin, David Margolis, Judd Hollander, Warren Bilker, Xiaoyan Han, Rakesh Mistry, Laurence Gavin, Pam Tolomeo, Jacqueleen Wise, Mary Wheeler, Baofeng Hu, Neil Fishman, David Royer, Ebbing Lautenbach. "The Effect of Total Household Decolonization on Clearance of Colonization with Methicillin-Resistant Staphylococcus aureus." Web (July 28, 2016).

Source: Society for Healthcare Epidemiology of America (SHEA)