Postdischarge decolonization plus education leads to fewer MRSA infections than education alone

Reference

Huang SS, Singh R, McKinnell JA, et al, for the Project CLEAR Trial. Decolonization to reduce postdischarge infection risk among MRSA carriers. N Engl J Med 2019;380(7):638-650.

Synopsis

This study included 2121 adult patients who were hospitalized and screened positive for MRSA within the previous 30 days. The investigators randomized the patients to receive either education plus a postdischarge MRSA decolonization strategy, or education alone. The education consisted of an informational binder about how MRSA is spread, along with recommendations for personal hygiene, laundry, and cleaning. The MRSA decolonization strategy consisted of at-home 4% rinse-off chlorhexidine baths, 0.12% chlorhexidine mouthwash, and 2% nasal mupirocin for 5 days twice per month for 6 months. Patients were followed up at 1 month, then at 3, 6, 9, and 12 months after hospital discharge. Full adherence to the decolonization strategy was achieved by 66% of the patients.The primary outcome was MRSA infection. Patients in the education plus decolonization group had fewer MRSA infections than the education alone group (6.3% vs 9.2%; hazard ratio [HR] 0.70; 95% CI 0.52 - 0.96; P = .03). Skin or soft-tissue infections and pneumonia were the most common types of infection. Overall, 85% of the patients who had MRSA infections required hospitalization. You would need to treat 30 patients with the decolonization strategy to prevent one MRSA infection and you would need to treat 34 patients to prevent one hospitalization associated with a MRSA infection at one year following discharge. Among patients who adhered fully to the intervention, the numbers were even lower (number needed to treat [NNT] = 26 to prevent one MRSA infection, and NNT = 27 to prevent one MRSA-associated hospitalization at one year). Infection from any cause was also significantly reduced in the decolonization group (19.6% vs 23.7%; HR 0.83; 0.70 - 0.99). Adverse events associated with the decolonization strategy occurred in only 4.2% of participants and were categorized as mild.