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

 描述(申请人提供)：社区相关的耐甲氧西林金黄色葡萄球菌(CA-MRSA)流行造成重大的健康和经济负担。由于CA-MRSA现在是社区和许多医疗保健环境中主要的MRSA克隆，临床医生和感染预防专家面临新的挑战。该社区已成为CA-MRSA毒力菌株传播到医院的重要和不断扩大的宿主，可能会增加医院内MRSA感染的严重程度。需要努力减轻MRSA在社区中的传播，减少CA-MRSA感染的负担。家庭是耐甲氧西林金黄色葡萄球菌传播的重要宿主和根除耐甲氧西林金黄色葡萄球菌的重要目标。我们先前的研究表明，由所有家庭成员执行的一次性非殖民化方案减少了(但没有消除)指标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，对个人非殖民化采取定期做法可能会提供持续的保护，防止CA-MRSA重新感染。此外，感染MRSA患者家庭的环境表面经常和持续地受到MRSA的污染；因此，家庭表面的净化可能会限制MRSA的获取和传播。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战略，以减轻CA-MRSA疾病的负担。具体地说，所有参与者(指示患者及其家庭接触者)将执行为期5天的基线MRSA非殖民化方案，包括加强卫生措施，每天两次将莫匹罗星抗生素软膏涂抹在前鼻孔，以及每天用洗必泰消毒剂清洗身体。根据为期5天的基线非殖民化计划，家庭将随机分为三个干预组：1)所有家庭成员定期进行个人非殖民化，包括3个月内每周洗两次洗必泰身体，并在3个月内连续5天滴鼻应用莫匹罗星；2)家庭环境卫生，包括有针对性地清洗家居表面和清洗床单，为期3个月；3)综合定期个人非殖民化和家庭环境卫生3个月。将对家庭进行9个月的跟踪，以衡量参与者和家庭环境中耐甲氧西林金黄色葡萄球菌的定居情况，并记录复发的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。每个恢复的MRSA分离株都将接受对莫匹罗星、洗必泰和全身抗生素的耐药性测试。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治疗的医疗利用，潜在地防止更多的CA-MRSA毒力菌株迁移到医院。

 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.