S. Aureus Decolonization in HPN Patients.

Long-term StaphyloCoccus Aureus decolonizAtion in Patients on Home parenteRal nutRition: a randomIzed multicEnter tRial.

This trial focusses on identifying the most effective and safe long-term S. aureus carriage decolonization strategy in home parenteral nutrition patients. Half of the participants will receive a quick and short systemic antibiotic treatment combined with topical treatment, while the other half will receive only topical treatment on a periodic basis.

Patients on home parenteral nutrition (HPN) are exposed to a lifelong risk of developing S. aureus bacteremia (SAB). SAB pose a threat to both catheter and patient survival and may lead to a permanent loss of vascular access. S. aureus carriage eradication has proven successful in prevention of S. aureus infections. S. aureus decolonization is a key strategy to maintain venous access and avoid hospitalization.

Inclusion Criteria:

• Patient is fully able to understand the nature of the proposed intervention.
• Written informed consent by the patient before entering the trial.
• Age ≥ 18 years.
• Estimated life expectancy ≥ 1 year.
• Patient colonized with S. aureus.

Exclusion Criteria:

• Cannot be expected to comply with the trial plan (substance abuse, mental condition).
• Pregnant or breastfeeding women.
• Continuous exposure to Methicillin-resistant S. aureus (MRSA; e.g. pig farmer).
• Allergy for chlorhexidine and betadine.
• No options for oral and/or topical antibiotics due to allergies.
• Active S. aureus infection.
• Currently on treatment with antibiotics active against S. aureus.
• Decolonization (including mupirocin) treatment in the previous two months.
• The presence of a nasal foreign body.
• Aspartate aminotransferase (AST) and Alanine aminotransferase (ALT) levels more than five times the upper limit of normal or liver failure.