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Inpatients with methicillin-resistant Staphylococcus aureus (MRSA) can prevent future MRSA infections following a standard bath protocol after discharge, according to research published in the February 14 issue of New England Journal of Medicine.
The CLEAR trial, on changing lives by eradicating antibiotic resistance, divided 2,121 adult patients at random into one of two groups. All patients in both groups were "colonized" with MRSA; that is to say that they were wearing MRSA silently on their bodies. One group received training on infection prevention measures related to personal hygiene, laundry and home cleaning, and the other group received the same training, as well as the other group. a teaching on decolonization, namely a therapeutic scheme to eliminate MRSA bacteria from their body. The decolonization regime consisted of taking a bath or shower with an over-the-counter antiseptic soap, rinsing the mouth and throat with a prescription mouthwash and applying antibiotic ointment to the nose. Patients learned to self-administer the decolonization regimen daily for five days, twice a month for six months.
"Our goal was to understand if removing MRSA from the skin, nose and throat was better than hygiene education alone to reduce MRSA or other infections. and badociated hospitalizations, "said Dr. Mary Hayden, Professor of Internal Medicine and Pathology, Head of Division. Infectious Diseases and Director, Clinical Microbiology Division, Rush University Medical Center.
In the group that received only one education, one in 11 (9.2%) participants contracted MRSA infection and one in four (23.7%) contracted a serious infection regardless of the pathogen. , most infections (85%) resulting in hospitalization.
The decolonization plus education regime reduced MRSA infections by 30% compared to the education-only group and reduced all types of infections by 17%. Patients who missed no dose of decolonization had 44% fewer MRSA infections and 40% fewer infections in total.
Participants in the study were recruited from 17 hospitals and seven retirement homes in Southern California (Orange County and Los Angeles County). Participants were adults who were able to bathe or shower (either alone or with the help of a health care provider), having been hospitalized for the past 30 days and tested positive for MRSA during their stay in the hospital or 30 days before or after. (California requires MRSA screening for admission to hospital for high-risk patients).
The researchers followed the patients for 12 months after they left the hospital. They met them at their home or at a research clinic four times and conducted an exit interview at the end of the year. They also contacted participants every month, asking them to report any hospitalizations or clinic visits for infection, and reviewed their medical records from the time of study.
National Centers for Disease Control data show that MRSA carriers leaving the hospital are at high risk of acquiring serious MRSA in the year following discharge. About 5 to 10% of hospitalized patients carry MRSA.
"Faced with a problem of this size, we wanted to find the best strategies to prevent these infections and badociated hospitalizations," Hayden said. "This large-scale clinical trial helped determine if there was a way to prevent infections after returning home patients and to avoid readmission."
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The study was conducted as part of longstanding collaborations between the University of California at Irvine, the Institute for Biomedical Research of Los Angeles at Harbor-UCLA and the Rush University.
The CLEAR project was funded by a grant (R01HS019388 from Dr. Huang) from the AHRQ program related to health care-badociated infections and by the UCI Research Institute for Clinical and Translational Sciences, funded by a grant from the NIH Clinical and Translational Science Award (UL1 TR000153).
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