Impact of MRSA Decolonization Therapy on MRSA Infection and Transmission

描述（由申请人提供）：耐甲氧西林金黄色葡萄球菌（MRSA）已成为与感染相关的主要病原体之一。MRSA感染与显著的发病率、死亡率和医疗费用增加有关。虽然MRSA的定植与感染和传播的风险显著增加有关，但MRSA定植的住院病人的去定植并不是标准的护理。标准的策略是隔离MRSA定植的患者，并采取接触预防措施，但不去定植患者。据我们所知，没有进行过比较标准隔离战略与非殖民化战略在发病率和出院后向家庭成员传播方面的有效性的试验。我们建议在以下终点比较不去菌落的标准患者隔离策略与对MRSA定殖的住院患者进行隔离和去菌落策略的有效性：A)降低指标患者出院前的感染率，B)降低指标住院期间未发生感染的患者出院后的再次感染，C)降低出院后MRSA对家庭成员的传播。该项目与医疗保健研究和质量机构的比较有效性组合的信息目标一致。我们将在南卡罗莱纳医科大学医院进行一项随机、双盲、安慰剂对照试验，研究对象为918名通过主动监测确定为MRSA定菌的成人（20岁）住院患者。通过使用随机化和双盲、安慰剂对照来进行莫匹罗星去殖民化，我们可以更好地确保两组之间的任何差异都可以归因于主动去殖民化策略的添加。随访时间为出院后18个月。除了评估指标患者出院前和出院后感染的发展情况以及指标患者向其家庭成员传播MRSA的情况外，我们还将评估非殖民化策略可能导致的莫匹罗星耐药性的发展情况。MRSA的传播和感染不仅对住院病人的发病率和死亡率有重大影响，而且对整个社区也有重大影响。更好地了解MRSA在医院非定殖的益处和风险对于开发控制MRSA有害后果的新方法至关重要。

DESCRIPTION (provided by applicant): Methicillin-resistant Staphylococcus aureus (MRSA) has emerged as one of the predominant pathogens associated with infections. MRSA infections have been associated with significant morbidity, mortality, and increased costs of care. Although colonization with MRSA is associated with a substantially increased risk for infection as well as transmission, decolonization of MRSA colonized hospital inpatients is not the standard of care. The standard strategy is to isolate the MRSA colonized patient and use contact precautions but not decolonize the patient. We know of no trials that have been conducted comparing the effectiveness of a standard isolation strategy with a decolonization strategy for both morbidity and transmission to household members post hospital discharge. We propose to compare the effectiveness of a standard patient isolation strategy without decolonization with a strategy of isolation and decolonization for hospital inpatients colonized with MRSA with respect to the following endpoints: A) reducing infection rates pre-discharge from the hospital among the index patients, B) reducing subsequent infections post-discharge among those without an infection in the index hospitalization, and C) reducing transmission of MRSA to household members post-discharge. This project is consistent with the informational goals of the Comparative Effectiveness portfolio at the Agency for Healthcare Research and Quality. We will conduct a randomized, double-blind, placebo-controlled trial among 918 adult (>20 years old) inpatients identified as colonized with MRSA through active surveillance at the Medical University of South Carolina Hospital. By using both randomization and a double-blind, placebo-control for mupirocin decolonization we are better assured that any differences between the two groups can be attributed to the addition of the active decolonization strategy. We will follow the index patients for 18 months post-discharge. In addition to assessing the development of infections pre and post-discharge from the hospital among the index patients and the transmission of MRSA from the index patients to their household members, we will also assess the development of mupirocin resistance that may result from the decolonization strategy. The implications of MRSA transmission and infection are substantial not only for morbidity and mortality in inpatient care but also for the community at large. A better understanding of the benefits and risks of MRSA decolonization in the hospital is essential to developing new methods for controlling the deleterious consequences of MRSA. PUBLIC HEALTH RELEVANCE: Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most commonly identified antimicrobial- resistant pathogens and is responsible for considerable morbidity and mortality. Mortality rates from MRSA have been estimated to surpass those caused by HIV infection. Colonization with MRSA is associated subsequent infections and transmission to other individuals yet decolonization regimens are not widely used in hospitals. This project is an attempt to determine if a new strategy can decrease infection and transmission of MRSA.