Integrating Personal and Household Environmental Hygiene Measures to Prevent Methicillin-Resistant Staphylococcus aureus Infection

 描述（由申请人提供）：社区相关耐甲氧西林金黄色葡萄球菌（CA-MRSA）流行病造成了重大的健康和经济负担。由于CA-MRSA现在是社区和许多医疗机构中主要的MRSA克隆，临床医生和感染预防专家面临着新的挑战。社区已成为一个重要的和不断扩大的水库传播致命的CA-MRSA菌株进入医院，可能增加医院MRSA感染的严重性。需要努力减轻MRSA在社区中的传播，并减少CA-MRSA感染的负担。家庭是MRSA传播的重要储存库，也是MRSA根除的重要目标。我们之前的研究表明，所有家庭成员进行的一次性去殖民化方案减少了（但没有消除）索引患者和家庭接触者的皮肤和软组织感染（SSTI）的发生率。鉴于CA-MRSA的广泛传播和持续暴露的风险，定期进行个人去殖民化可能会提供持续的保护，防止CA-MRSA再感染。此外，MRSA感染患者家庭的环境表面经常和持续受到MRSA污染;因此，家庭表面的去污可以限制MRSA的获得和传播。CA-MRSA感染的儿科患者及其家庭成员将被招募参加一项务实的比较有效性试验，评估个人和家庭环境卫生策略，以减少CA-MRSA疾病的负担。具体而言，所有参与者（索引患者及其家庭接触者）将执行基线5天MRSA去殖民化方案，包括加强卫生措施，每天两次在前鼻孔应用莫匹罗星抗生素软膏，每天用氯己定消毒剂沐浴。在5天基线去殖民化方案之后，家庭将被随机分配到三个干预组之一：1）由所有家庭成员进行定期个人去殖民化，包括每周两次洗必泰沐浴液，持续3个月，以及每月连续5天应用鼻内莫匹罗星，持续3个月; 2）家庭环境卫生，包括有针对性地清洁家庭表面和清洗床单，每周一次，持续3个月;（3）将定期个人去殖民化和家居环境卫生结合起来，为期3个月。将对家庭进行9个月的随访，以测量参与者和家庭环境中MRSA定植的患病率，并记录复发性SSTI的发生率。将对所有回收的MRSA分离株进行分子菌株分型，以阐明传播动力学。将检测每株回收的MRSA分离株对莫匹罗星、氯己定和全身性抗生素的耐药性。拟议的试验将确定减少CA-MRSA感染发生率的最佳策略，从而减少CA-MRSA治疗的医疗保健利用，可能防止致命的CA-MRSA菌株额外迁移到医院。

 DESCRIPTION (provided by applicant): The community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) epidemic poses a significant health and economic burden. As CA-MRSA is now the predominant MRSA clone in the community and in many healthcare settings, clinicians and infection prevention specialists face new challenges. The community has become an important and expanding reservoir for the spread of virulent CA-MRSA strains into hospitals, likely increasing the severity of nosocomial MRSA infections. Efforts are needed to mitigate the spread of MRSA in the community and decrease the burden of CA-MRSA infections. Households are significant reservoirs for MRSA transmission and important targets for MRSA eradication. Our prior study demonstrated that a one-time decolonization regimen performed by all household members reduced (but did not eliminate) the incidence of skin and soft tissue infection (SSTI) in index patients and household contacts. Given the widespread dissemination of CA-MRSA and risk for ongoing exposure, a periodic approach to personal decolonization may provide sustained protection against CA-MRSA reacquisition. Additionally, environmental surfaces in households of patients with MRSA infection are frequently and persistently contaminated with MRSA; thus, decontamination of household surfaces may limit the acquisition and spread of MRSA. Pediatric patients with CA-MRSA infection and their household members will be recruited to participate in a pragmatic comparative effectiveness trial evaluating personal and household environmental hygiene strategies to decrease the burden of CA-MRSA disease. Specifically, all participants (index patients and their household contacts) will perform a baseline 5-day MRSA decolonization protocol consisting of enhanced hygiene measures, application of mupirocin antibiotic ointment to the anterior nares twice daily, and daily body washes with chlorhexidine antiseptic. Following the 5-day baseline decolonization regimen, households will be randomized to one of three intervention groups: 1) Periodic personal decolonization performed by all household members, to include chlorhexidine body washes twice weekly for 3 months and application of intranasal mupirocin for 5 consecutive days each month for 3 months; 2) Household environmental hygiene, including targeted cleaning of household surfaces and laundering of bed linens, weekly for 3 months; and 3) Integrated periodic personal decolonization and household environmental hygiene for 3 months. Households will be followed for 9 months to measure the prevalence of MRSA colonization in the participants and the household environment and to document the incidence of recurrent SSTI. Molecular strain typing will be performed on all recovered MRSA isolates to illuminate transmission dynamics. Each recovered MRSA isolate will be tested for resistance to mupirocin, chlorhexidine, and systemic antibiotics. The proposed trial will identify best strategie for curtailing the incidence of CA-MRSA infections, thus reducing healthcare utilization for CA-MRSA treatment, potentially preventing additional migration of virulent CA-MRSA strains into hospitals.