Huang SS, et al. - Since a high risk for post-discharge infection has been reported in hospitalized patients who are colonized with methicillin-resistant Staphylococcus aureus (MRSA), researchers compared postdischarge hygiene education to education plus decolonization in patients colonized with MRSA (carriers). In this multicenter, randomized, controlled trial, a 30% lower risk of MRSA infection was observed in association with postdischarge MRSA decolonization with chlorhexidine and mupirocin vs education alone.

Methods

• They performed decolonization by using chlorhexidine mouthwash, baths or showers with chlorhexidine, and nasal mupirocin for 5 days twice per month for 6 months.
• They carried out 1 year follow-up in participants.
• Using Centers for Disease Control and Prevention (CDC) criteria, they assessed MRSA infection ( primary outcome).
• Based on clinical judgment, infection from any cause, and infection-related hospitalization, MRSA infection was further assessed (secondary outcomes).
• They used per-protocol population (all participants who underwent randomization, met the inclusion criteria, and survived beyond the recruitment hospitalization) and as-treated population (participants stratified according to adherence) on whom proportional-hazards models were applied in all analyses.

Results

• In the per-protocol population, the occurrence of MRSA infection was reported in 98/1063 (9.2%) and in 67/1058 (6.3%) participants in the education group and in the decolonization group, respectively, 84.8% of the MRSA infections led to hospitalization.
• In the education group and in the decolonization group, the occurrence of infection from any cause was reported in 23.7% of the participants and in 19.6%, respectively, 85.8% of the infections led to hospitalization.
• The decolonization group vs the education group had significantly lower hazard of MRSA infection (hazard ratio, 0.70; 95% confidence interval [CI], 0.52 to 0.96; P=0.03; number needed to treat to prevent one infection, 30; 95% CI, 18 to 230); this lower hazard was responsible for a lower risk of hospitalization due to MRSA infection (hazard ratio, 0.71; 95% CI, 0.51 to 0.99).
• They noted lower likelihoods of clinically judged infection from any cause (hazard ratio, 0.83; 95% CI, 0.70 to 0.99) and infection-related hospitalization (hazard ratio, 0.76; 95% CI, 0.62 to 0.93) in the decolonization group; exercising caution was recommended while interpreting treatment effects for secondary outcomes due to a lack of prespecified adjustment for multiple comparisons.
• In as-treated analyses, 44% fewer MRSA infections were noted in participants in the decolonization group who adhered fully to the regimen vs the education group (hazard ratio, 0.56; 95% CI, 0.36 to 0.86), the former group also had 40% fewer infections from any cause (hazard ratio, 0.60; 95% CI, 0.46 to 0.78).
• In 4.2% of the participants, the occurrence of side effects (all mild) were noted.