HOME2 Study: Household Versus Personalized Decolonization in Households of Children With Methicillin-Resistant Staphylococcus aureus Skin and Soft Tissue Infection—A Randomized Clinical Trial

作者：Patrick G. Hogan, Katelyn L. Parrish, Ryan L. Mork, Mary G. Boyle, Carol E. Muenks, Ryley M. Thompson, John Morelli, Melanie L. Sullivan, David A. Hunstad, Juliane Bubeck Wardenburg, Andrey Rzhetsky, Sarah Gehlert, Carey‐Ann D. Burnham, Stephanie A. Fritz · 发表于：Clinical Infectious Diseases · 年份：2020 · DOI：10.1093/cid/ciaa752 · 被引用次数：27 · 研究领域：Antimicrobial Resistance in Staphylococcus、Streptococcal Infections and Treatments、Infection Control in Healthcare

BACKGROUND: A household approach to decolonization decreases skin and soft tissue infection (SSTI) incidence, though this is burdensome and costly. As prior SSTI increases risk for SSTI, we hypothesized that the effectiveness of decolonization measures to prevent SSTI when targeted to household members with prior year SSTI would be noninferior to decolonizing all household members. METHODS: Upon completion of our 12-month observational Household Observation of Methicillin-resistant Staphylococcus aureus in the Environment (HOME) study, 102 households were enrolled in HOME2, a 12-month, randomized noninferiority trial. Pediatric index patients with community-associated methicillin-resistant Staphylococcus aureus (MRSA) SSTI, their household contacts, and pets were enrolled. Households were randomized 1:1 to the personalized (decolonization performed only by household members who experienced SSTI during the HOME study) or household (decolonization performed by all household members) approaches. The 5-day regimen included hygiene education, twice-daily intranasal mupirocin, and daily bleach-water baths. At 5 follow-up visits in participants' homes, swabs to detect S. aureus were collected from participants, environmental surfaces, and pets; incident SSTIs were ascertained. RESULTS: Noninferiority of the personalized approach was established for the primary outcome 3-month cumulative SSTI: 23 of 212 (10.8%) participants reported SSTI in household approach households, while 23 of ...