Evaluating Personal and Environmental Decolonization Strategies for Children with Skin and Soft Tissue Infection and Their Households - A Randomized Clinical Trial.

Abstract

Staphylococcus aureus colonization predisposes to skin and soft tissue infection (SSTI). Given the waning effectiveness of decolonization, we evaluated periodic personal decolonization and household environmental decontamination to reduce SSTIs among households affected by S. aureus. Households of children with community-associated S. aureus SSTI participated in an open-label randomized trial. After baseline decolonization, households were randomized 1:1:1 to a 3-month decolonization intervention: 1) Periodic-Personal (twice weekly chlorhexidine bathing and monthly intranasal mupirocin application); 2) Environmental-Hygiene (weekly household surface disinfection and enhanced laundry measures); or 3) Integrated-Approach of both Periodic-Personal and Environmental-Hygiene. Over 9 months, participants and household surfaces were sampled at 5 study visits to detect S. aureus; SSTI incidence was recorded. The primary outcome was household-level cumulative SSTI at 3 months, comparing the Integrated-Approach to the combined Personal-Periodic and Environmental-Hygiene groups. Between 2015-2021, 196 index patients and their household contacts (n=623) were enrolled. Cumulative SSTI incidence did not differ between groups during the 3-month intervention. In index patients and household contacts with SSTI in the year prior to enrollment, SSTI incidence was lower among the Integrated-Approach at 6- and 9-months compared to the combined Periodic-Personal and Environmental-Hygiene groups. In multivariable analyses, prior year SSTI was associated with subsequent SSTI; intervention group was not significant. All interventions reduced MRSA, but not MSSA, personal colonization over 9 months. While an Integrated-Approach of prolonged personal and environmental decolonization reduced SSTIs among participants with prior year SSTI, prior SSTI strongly predicted SSTI incidence longitudinally. Novel prevention strategies are needed.