Comparative Effectiveness Study of Home-Based Interventions to Prevent CA-MRSA Infection Recurrence

Abstract

BACKGROUNDRecurrent skin and soft tissue infections (SSTI) caused by Community-Associated Methicillin-Resistant (CA-MRSA) or Methicillin-Sensitive Staphylococcus aureus (CA-MSSA) present treatment challenges.OBJECTIVESCan an evidence-based intervention (CDC Guidelines, topical decolonization, surface decontamination) reduce SSTI recurrence, mitigate household contamination and transmission, and improve patient-reported outcomes?DESIGNRandomized trialSETTINGCommunity settingsPARTICIPANTSParticipants (n=186) with confirmed MRSA(+)/MSSA(+) SSTIs and household members.INTERVENTION Community Health Workers/Promotoras conducted home visits and provided participants with instructions, a five-day supply of mupirocin for nasal application, chlorhexidine for body cleansing, and disinfecting wipes for household cleaning (EXP) versus Usual Care (UC).MEASUREMENTSPrimary outcome was six-month SSTI recurrence recorded in electronic health records (EHR). Home visits (months 0/3) and telephone assessments (months 0/1/6) collected self-report data. Surveillance culture swabs (nares, axilla, groin) were obtained from index patients and participating household members. Secondary outcomes included household surface contamination, household member colonization and transmission, quality of life and satisfaction with care.RESULTSAmong patients with SSTIs (n=421), 44.2% were MRSA(+)/MSSA(+); an intent-to-treat analyses (n=186) demonstrated no significant differences in SSTI recurrence (OR: 1.4, 95% CI: 0.51-3.5). Among the enrolled cohort (n=119), there were no significant SSTI recurrence effects (OR=1.14, 95% CI=0.35-3.6). EXP participants showed reduced but non-significant colonization rates. There were no differential reductions in household member transmission or in reductions in proportions of households with ≥1 contaminated surface. Mupirocin resistance did not increase. No significant improvements for patient-reported outcomes were seen.LIMITATIONSA lower-than-predicted six-month recurrence rate may have limited the ability to detect effects.CONCLUSIONThis intervention did not reduce clinician-reported MRSA/MSSA SSTI recurrence. No differences were observed for household members decolonization or household surfaces decontamination.