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Decolonization Lowers Postdischarge Infection Risk

N Engl J Med; 2019 Feb 14; Huang, et al

In patients colonized with methicillin-resistant Staphylococcus aureus (MRSA), postdischarge MRSA decolonization with chlorhexidine and mupirocin led to a 30% lower risk of MRSA infection than education alone, a new study found. Researchers conducted a multicenter, randomized, controlled trial of postdischarge hygiene education, as compared with education plus decolonization, in patients colonized with MRSA. Decolonization involved chlorhexidine mouthwash, baths or showers with chlorhexidine, and nasal mupirocin for 5 days twice per month for 6 months. Participants were followed for 1 year. The primary outcome was MRSA infection. Among the findings:

  • MRSA infection occurred in 98 of 1,063 participants (9.2%) in the education group and in 67 of 1,058 (6.3%) in the decolonization group; 84.8% of the MRSA infections led to hospitalization.
  • Infection from any cause occurred in 23.7% of participants in the education group vs 19.6% in the decolonization group; 85.3% of these infections led to hospitalizations.
  • The hazard of MRSA infection was significantly lower in the decolonization group vs the education group and led to a lower risk of hospitalization due to MRSA infection.

Citation:

Huang SS, Singh R, McKinnell JA, et al. Decolonization to reduce postdischarge infection risk among MRSA carriers. N Engl J Med. 2019;380:638-650. doi:10.1056/NEJMoa1716771.