Randomized, double-blind, placebocontrolled study on decolonization procedures for methicillin-resistant Staphylococcus aureus (MRSA) among HIV-infected adults

Amy Weintrob, Ionut Bebu, Brian Agan, Alona Diem, Erica Johnson, Tahaniyat Lalani, Xun Wang, Mary Bavaro, Michael Ellis, Katrin Mende, Nancy Crum-Cianflone

Research output: Contribution to journalArticle

Abstract

Background: HIV-infected persons have increased risk of MRSA colonization and skin and soft-tissue infections (SSTI). However, no large clinical trial has examined the utility of decolonization procedures in reducing MRSA colonization or infection among community-dwelling HIVinfected persons. Methods: 550 HIV-infected adults at four geographically diverse US military HIV clinics were prospectively screened for MRSA colonization at five body locations every 6 months during a 2-year period. Those colonized were randomized in a double-blind fashion to nasal mupirocin (Bactroban) twice daily and hexachlorophene (pHisoHex) soaps daily for 7 days compared to placeboes similar in appearance but without specific antibacterial activity. The primary endpoint was MRSA colonization at 6-months post-randomization; secondary endpoints were time to MRSA clearance, subsequent MRSA infections/SSTI, and predictors for MRSA clearance at the 6-month time point. Results: Forty-nine (9%) HIV-infected persons were MRSA colonized and randomized. Among those with 6-month colonization data (80% of those randomized), 67% were negative for MRSA colonization in both groups (p = 1.0). Analyses accounting for missing 6-month data showed no significant differences could have been achieved. In the multivariate adjusted models, randomization group was not associated with 6-month MRSA clearance. The median time to MRSA clearance was similar in the treatment vs. placebo groups (1.4 vs. 1.8 months, p = 0.35). There was no difference on subsequent development of MRSA infections/SSTI (p = 0.89). In a multivariable model, treatment group, demographics, and HIVspecific factors were not predictive of MRSA clearance at the 6-month time point. Conclusion: A one-week decolonization procedure had no effect on MRSA colonization at the 6-month time point or subsequent infection rates among community-dwelling HIV-infected persons. More aggressive or novel interventions may be needed to reduce the burden of MRSA in this population.

Original languageEnglish (US)
Article numbere0128071
JournalPLoS One
Volume10
Issue number5
DOIs
StatePublished - May 1 2015
Externally publishedYes

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Methicillin
Methicillin-Resistant Staphylococcus aureus
Double-Blind Method
HIV
Soft Tissue Infections
infection
skin (animal)
Mupirocin
Independent Living
Skin
methicillin-resistant Staphylococcus aureus
Tissue
Random Allocation
Infection
endpoints
hexachlorophene
Hexachlorophene
Triclosan
Soaps
Soaps (detergents)

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

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Randomized, double-blind, placebocontrolled study on decolonization procedures for methicillin-resistant Staphylococcus aureus (MRSA) among HIV-infected adults. / Weintrob, Amy; Bebu, Ionut; Agan, Brian; Diem, Alona; Johnson, Erica; Lalani, Tahaniyat; Wang, Xun; Bavaro, Mary; Ellis, Michael; Mende, Katrin; Crum-Cianflone, Nancy.

In: PLoS One, Vol. 10, No. 5, e0128071, 01.05.2015.

Research output: Contribution to journalArticle

Weintrob, Amy ; Bebu, Ionut ; Agan, Brian ; Diem, Alona ; Johnson, Erica ; Lalani, Tahaniyat ; Wang, Xun ; Bavaro, Mary ; Ellis, Michael ; Mende, Katrin ; Crum-Cianflone, Nancy. / Randomized, double-blind, placebocontrolled study on decolonization procedures for methicillin-resistant Staphylococcus aureus (MRSA) among HIV-infected adults. In: PLoS One. 2015 ; Vol. 10, No. 5.
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abstract = "Background: HIV-infected persons have increased risk of MRSA colonization and skin and soft-tissue infections (SSTI). However, no large clinical trial has examined the utility of decolonization procedures in reducing MRSA colonization or infection among community-dwelling HIVinfected persons. Methods: 550 HIV-infected adults at four geographically diverse US military HIV clinics were prospectively screened for MRSA colonization at five body locations every 6 months during a 2-year period. Those colonized were randomized in a double-blind fashion to nasal mupirocin (Bactroban) twice daily and hexachlorophene (pHisoHex) soaps daily for 7 days compared to placeboes similar in appearance but without specific antibacterial activity. The primary endpoint was MRSA colonization at 6-months post-randomization; secondary endpoints were time to MRSA clearance, subsequent MRSA infections/SSTI, and predictors for MRSA clearance at the 6-month time point. Results: Forty-nine (9{\%}) HIV-infected persons were MRSA colonized and randomized. Among those with 6-month colonization data (80{\%} of those randomized), 67{\%} were negative for MRSA colonization in both groups (p = 1.0). Analyses accounting for missing 6-month data showed no significant differences could have been achieved. In the multivariate adjusted models, randomization group was not associated with 6-month MRSA clearance. The median time to MRSA clearance was similar in the treatment vs. placebo groups (1.4 vs. 1.8 months, p = 0.35). There was no difference on subsequent development of MRSA infections/SSTI (p = 0.89). In a multivariable model, treatment group, demographics, and HIVspecific factors were not predictive of MRSA clearance at the 6-month time point. Conclusion: A one-week decolonization procedure had no effect on MRSA colonization at the 6-month time point or subsequent infection rates among community-dwelling HIV-infected persons. More aggressive or novel interventions may be needed to reduce the burden of MRSA in this population.",
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AU - Weintrob, Amy

AU - Bebu, Ionut

AU - Agan, Brian

AU - Diem, Alona

AU - Johnson, Erica

AU - Lalani, Tahaniyat

AU - Wang, Xun

AU - Bavaro, Mary

AU - Ellis, Michael

AU - Mende, Katrin

AU - Crum-Cianflone, Nancy

PY - 2015/5/1

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N2 - Background: HIV-infected persons have increased risk of MRSA colonization and skin and soft-tissue infections (SSTI). However, no large clinical trial has examined the utility of decolonization procedures in reducing MRSA colonization or infection among community-dwelling HIVinfected persons. Methods: 550 HIV-infected adults at four geographically diverse US military HIV clinics were prospectively screened for MRSA colonization at five body locations every 6 months during a 2-year period. Those colonized were randomized in a double-blind fashion to nasal mupirocin (Bactroban) twice daily and hexachlorophene (pHisoHex) soaps daily for 7 days compared to placeboes similar in appearance but without specific antibacterial activity. The primary endpoint was MRSA colonization at 6-months post-randomization; secondary endpoints were time to MRSA clearance, subsequent MRSA infections/SSTI, and predictors for MRSA clearance at the 6-month time point. Results: Forty-nine (9%) HIV-infected persons were MRSA colonized and randomized. Among those with 6-month colonization data (80% of those randomized), 67% were negative for MRSA colonization in both groups (p = 1.0). Analyses accounting for missing 6-month data showed no significant differences could have been achieved. In the multivariate adjusted models, randomization group was not associated with 6-month MRSA clearance. The median time to MRSA clearance was similar in the treatment vs. placebo groups (1.4 vs. 1.8 months, p = 0.35). There was no difference on subsequent development of MRSA infections/SSTI (p = 0.89). In a multivariable model, treatment group, demographics, and HIVspecific factors were not predictive of MRSA clearance at the 6-month time point. Conclusion: A one-week decolonization procedure had no effect on MRSA colonization at the 6-month time point or subsequent infection rates among community-dwelling HIV-infected persons. More aggressive or novel interventions may be needed to reduce the burden of MRSA in this population.

AB - Background: HIV-infected persons have increased risk of MRSA colonization and skin and soft-tissue infections (SSTI). However, no large clinical trial has examined the utility of decolonization procedures in reducing MRSA colonization or infection among community-dwelling HIVinfected persons. Methods: 550 HIV-infected adults at four geographically diverse US military HIV clinics were prospectively screened for MRSA colonization at five body locations every 6 months during a 2-year period. Those colonized were randomized in a double-blind fashion to nasal mupirocin (Bactroban) twice daily and hexachlorophene (pHisoHex) soaps daily for 7 days compared to placeboes similar in appearance but without specific antibacterial activity. The primary endpoint was MRSA colonization at 6-months post-randomization; secondary endpoints were time to MRSA clearance, subsequent MRSA infections/SSTI, and predictors for MRSA clearance at the 6-month time point. Results: Forty-nine (9%) HIV-infected persons were MRSA colonized and randomized. Among those with 6-month colonization data (80% of those randomized), 67% were negative for MRSA colonization in both groups (p = 1.0). Analyses accounting for missing 6-month data showed no significant differences could have been achieved. In the multivariate adjusted models, randomization group was not associated with 6-month MRSA clearance. The median time to MRSA clearance was similar in the treatment vs. placebo groups (1.4 vs. 1.8 months, p = 0.35). There was no difference on subsequent development of MRSA infections/SSTI (p = 0.89). In a multivariable model, treatment group, demographics, and HIVspecific factors were not predictive of MRSA clearance at the 6-month time point. Conclusion: A one-week decolonization procedure had no effect on MRSA colonization at the 6-month time point or subsequent infection rates among community-dwelling HIV-infected persons. More aggressive or novel interventions may be needed to reduce the burden of MRSA in this population.

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