TY - JOUR
T1 - HoMe2 study
T2 - Household Versus Personalized Decolonization in Households of Children With Methicillin-Resistant Staphylococcus aureus Skin and Soft Tissue Infection—A Randomized Clinical Trial
AU - Hogan, Patrick G.
AU - Parrish, Katelyn L.
AU - Mork, Ryan L.
AU - Boyle, Mary G.
AU - Muenks, Carol E.
AU - Thompson, Ryley M.
AU - Morelli, John J.
AU - Sullivan, Melanie L.
AU - Hunstad, David A.
AU - Wardenburg, Juliane Bubeck
AU - Rzhetsky, Andrey
AU - Gehlert, Sarah J.
AU - Burnham, Carey Ann D.
AU - Fritz, Stephanie A.
N1 - Funding Information:
This work was supported by the Children’s Discovery Institute of Washington University and St Louis Children’s Hospital (to S. A. F.); NIH/National Institute of Allergy and Infectious Diseases (grant number K23-AI091690) to S. A. F.; the National Center for Advancing Translational Sciences at the NIH (grant number UL1-TR002345) to S. A. F.; the AHRQ (grant numbers R01-HS021736 and R01-HS024269) to S. A. F.; and the Burroughs Wellcome Foundation Investigators in the Pathogenesis of Infectious Disease Award (to J. B. W.). The computational analysis was partially funded by the Defense Advanced Research Projects Agency Big Mechanism program (Army Research Office contract W911NF1410333) to A. R.; by the NIH (grant numbers R01HL122712, 1P50MH094267, and U01HL108634) to A. R.; and by a gift from Liz and Kent Dauten) to A. R.
Publisher Copyright:
© The Author(s) 2020.
PY - 2021/12/1
Y1 - 2021/12/1
N2 - 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 236 (9.7%) participants reported SSTI in personalized approach households (difference in proportions, -1.1% [95% confidence interval, -6.7% to 4.5%]). In multivariable analyses, prior year SSTI and baseline MRSA colonization were associated with cumulative SSTI. Conclusions. The personalized approach was noninferior to the household approach in preventing SSTI. Future studies should interrogate longer durations of decolonization and/or decontamination of the household environment to reduce household MRSA burden.
AB - 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 236 (9.7%) participants reported SSTI in personalized approach households (difference in proportions, -1.1% [95% confidence interval, -6.7% to 4.5%]). In multivariable analyses, prior year SSTI and baseline MRSA colonization were associated with cumulative SSTI. Conclusions. The personalized approach was noninferior to the household approach in preventing SSTI. Future studies should interrogate longer durations of decolonization and/or decontamination of the household environment to reduce household MRSA burden.
KW - Bleach
KW - Decolonization
KW - Methicillin-resistant staphylococcus aureus
KW - Mupirocin
KW - Skin and soft tissue infection
UR - http://www.scopus.com/inward/record.url?scp=85122546247&partnerID=8YFLogxK
U2 - 10.1093/cid/ciaa752
DO - 10.1093/cid/ciaa752
M3 - Article
C2 - 32521007
AN - SCOPUS:85122546247
SN - 1058-4838
VL - 73
SP - E4568-E4577
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 11
ER -