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MRSA decolonization may reduce the risk of subsequent MRSA infection and further transmission. A recent randomized controlled trial demonstrated that systemic decolonization may be safe and effective among hospitalized patients when compared to no treatment. As a large number of the investigators patients require re-admission and further transmission may take place in the community, the investigators are comparing the standard decolonization protocol for MRSA eradication to the systemic decolonization protocol among an ambulatory population.
Standard decolonization protocols, which use only topical agents, are limited in efficacy. The method of systemic decolonization to be studied here appears to have greater efficacy than the standard approach using only topical agents. However, concerns have been raised that the increased use of systemic antibiotics may lead to increased levels of drug resistance adverse effects, without sustained decolonization. This study seeks to provide further data to help answer these questions and provide guidance for further policy development and implementation.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Systemic decolonization | Experimental | 7-day course of 4% chlorhexidine gluconate daily washes and 2% mupirocin ointment to the anterior nares twice daily in addition to oral rifampin (600mg daily), and doxycycline (100mg twice daily) |
|
| Standard decolonization | Active Comparator | 7-day course of 2% mupirocin ointment to the anterior nares twice daily and 4% chlorhexidine gluconate washes once per day. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Rifampin | Drug | 600mg po once daily x 7 days |
| |
| Measure | Description | Time Frame |
|---|---|---|
| Rates of sustained decolonization at 1 month, 3 months, 6 months and 12 months | To compare standard versus systemic decolonization for their ability to sustain MRSA decolonization up to one year post-decolonization. | 12 months |
| Measure | Description | Time Frame |
|---|---|---|
| Changes in susceptibility patterns of MRSA isolates. | Study isolates will be evaluated with regards to mupirocin, rifampin and tetracycline resistance patterns, where individuals remain colonized, or re-colonize subsequent to implementation of the decolonization protocol. | 12 months |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Duncan Webster, MA, MD | Horizon Health Network | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Saint John Regional Hospital | Saint John | New Brunswick | E2L4L2 | Canada |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 17173213 | Background | Simor AE, Phillips E, McGeer A, Konvalinka A, Loeb M, Devlin HR, Kiss A. Randomized controlled trial of chlorhexidine gluconate for washing, intranasal mupirocin, and rifampin and doxycycline versus no treatment for the eradication of methicillin-resistant Staphylococcus aureus colonization. Clin Infect Dis. 2007 Jan 15;44(2):178-85. doi: 10.1086/510392. Epub 2006 Dec 14. |
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| Doxycycline |
| Drug |
100mg po twice daily x 7 days |
|
| 2% mupirocin ointment | Other | ~ 1cm applied to the anterior nares twice daily for 7 days |
|
| 4% chlorhexidine gluconate | Other | Daily full body wash (including hair) for 7 days |
|
| ID | Term |
|---|---|
| D012293 | Rifampin |
| D004318 | Doxycycline |
| C010882 | chlorhexidine gluconate |
| ID | Term |
|---|---|
| D012294 | Rifamycins |
| D006576 | Heterocyclic Compounds, 4 or More Rings |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
| D006571 | Heterocyclic Compounds |
| D047029 | Lactams, Macrocyclic |
| D047028 | Macrocyclic Compounds |
| D011083 | Polycyclic Compounds |
| D013754 | Tetracyclines |
| D009279 | Naphthacenes |
| D011084 | Polycyclic Aromatic Hydrocarbons |
| D006841 | Hydrocarbons, Aromatic |
| D006844 | Hydrocarbons, Cyclic |
| D006838 | Hydrocarbons |
| D009930 | Organic Chemicals |
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