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

结合个人及家居环境卫生措施预防耐甲氧西林金黄色葡萄球菌感染

• 批准号: 9005044
• 负责人: Stephanie Ann Fritz
• 金额: $ 50万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-01 至 2020-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9005044
• 关键词: Integrating; Personal; Household; Environmental; Hygiene

 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.

 描述（由申请人提供）：与社区相关的耐甲氧西林金黄色葡萄球菌 (CA-MRSA) 流行造成了重大的健康和经济负担，因为 CA-MRSA 目前是社区和许多医疗机构中主要的 MRSA 克隆。感染预防专家面临着新的挑战。社区已成为剧毒 CA-MRSA 菌株向医院传播的重要且不断扩大的储存库，可能会加剧医院内 MRSA 感染的严重性。需要努力减轻 MRSA 在社区中的传播，并减轻 CA-MRSA 感染的负担。家庭是 MRSA 传播的重要储存库，也是根除 MRSA 的重要目标。鉴于 CA-MRSA 的广泛传播和持续接触的风险，家庭成员减少（但并未消除）指示患者和家庭接触者的皮肤和软组织感染 (SSTI) 发生率。个人去定植可提供持续的保护，防止 CA-MRSA 重新感染。此外，MRSA 感染患者的家庭环境表面经常受到 MRSA 污染；因此，对家庭表面进行净化可能会限制 CA-MRSA 儿童患者的感染和传播。 - MRSA 感染者及其家庭成员将被招募参加一项实用的比较有效性试验，评估个人和家庭环境卫生策略，以减轻 CA-MRSA 疾病的负担。接触者）将执行为期 5 天的 MRSA 去定植方案，包括加强卫生措施、每天两次在前鼻孔涂抹莫匹罗星抗生素软膏以及每天用氯己定消毒剂清洗身体。随机分配到三个干预组之一：1) 由所有家庭成员定期进行个人去殖民化，包括每周两次氯己定沐浴液，持续 3 个月，并使用每月连续 5 天滴鼻莫匹罗星，持续 3 个月；2) 家庭环境卫生，包括每周有针对性地清洁家庭表面和清洗床单，持续 3 个月；以及 3) 定期进行个人去殖民化和家庭环境卫生综合，持续 3 个月。对家庭进行为期 9 个月的跟踪，以测量参与者和家庭环境中 MRSA 定植的流行率，并记录复发性 SSTI 的发生率。将对所有康复者进行分子菌株分型。 MRSA 分离株可阐明传播动态。将测试每种回收的 MRSA 分离株对莫匹罗星、氯己定和全身抗生素的耐药性。拟议的试验将确定减少 CA-MRSA 感染发生率的最佳策略，从而减少医疗保健中对 CA-MRSA 的利用。治疗，有可能防止致命的 CA-MRSA 菌株进一步迁移到医院。