NEW YORK (Reuters Health) – When a child has a Staphylococcus aureus skin abscess, decolonizing all household members rather than just the individual patient leads to a lower incidence of infections in the following months, according to a report in Clinical Infectious Diseases online December 23.
“If decolonization measures are prescribed for patients with recurrent SSTI (skin and soft tissue infection), the findings of this study support an approach directed at all household members,” the authors suggest.
Dr. Stephanie A. Fritz and colleagues at Washington University School of Medicine in St. Louis, Missouri, note that there is an ongoing community-associated S. aureus epidemic that affects millions of individuals in the US. “This entity is particularly challenging within households, where the reservoir of S. aureus may perpetuate ongoing disease,” they continue.
While decolonization measures are often prescribed for infected patients with the aim of preventing recurrence, the team explains, it is unclear whether decolonizing all household members is helpful.
To investigate, they conducted a randomized open-label study involving 183 pediatric patients with S. aureus skin abscesses. In half the cases, just the index patient underwent decolonization after the acute SSTI had healed, while in the other half all household members performed the procedure.
The decolonization protocol was a 5-day regimen of twice-daily intranasal mupirocin and daily chlorhexidine body washes, and all participants were instructed to avoid sharing items such as towels or brushes, to use liquid soaps, and to launder bed linens at least weekly.
Eradication rates of S. aureus in the index patients at 1 month were no different in the two arms of the study: 51% in the household decolonization group and 50% in the individual decolonization group (p=1.00), the authors report. Corresponding rates at 12 months were 66% vs 54% (p=0.28).
However, 1-year recurrent SSTI rates in the index patients were significantly lower in the household group (52%) than in the individual group (72%; p=0.02), the investigators found.
Furthermore, SSTI incidence among household members at 6 months was 9% in the household decolonization group versus 16% in the individual decolonization arm (p=0.04), with the trend continuing at 12 months (16% vs 22%, p=0.10), Dr. Fritz and colleagues report.
“This is the first randomized trial of S. aureus decolonization strategies in the community setting to demonstrate a reduction in the burden of SSTI,” they conclude.
“However,” they comment, “this study is only a first step in demonstrating that a household approach can decrease the impact of S. aureus, as >50% of cases in the household group reported recurrent SSTI over a 1-year period.”
SOURCE:
Clin Infect Dis 2011.
