Randomized controlled trial of a self-administered five-day antiseptic bundle versus usual disinfectant soap showers for preoperative eradication of Staphylococcus aureus colonization

Susan E Kline, Jim Neaton, Ruth Lynfield, Patricia Ferrieri, Shalini L Kulasingam, Kayleigh Dittes, Anita Glennen, Selina Jawahir, Alexander Kaizer, Jeremiah S Menk, James R Johnson

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Objective To determine the efficacy in eradicating Staphylococcus aureus (SA) carriage of a 5-day preoperative decolonization bundle compared to 2 disinfectant soap showers, with both regimens self-administered at home.Design Open label, single-center, randomized clinical trial.Setting Ambulatory orthopedic, urologic, neurologic, colorectal, cardiovascular, and general surgery clinics at a tertiary-care referral center in the United States.Participants Patients at the University of Minnesota Medical Center planning to have elective surgery and not on antibiotics.Methods Consenting participants were screened for SA colonization using nasal, throat, axillary, and perianal swab cultures. Carriers of SA were randomized, stratified by methicillin resistance status, to a decolonization bundle group (5 days of nasal mupirocin, chlorhexidine gluconate [CHG] bathing, and CHG mouthwash) or control group (2 preoperative showers with antiseptic soap). Colonization status was reassessed preoperatively. The primary endpoint was absence of SA at all 4 screened body sites.Results Of 427 participants screened between August 31, 2011, and August 9, 2016, 127 participants (29.7%) were SA carriers. Of these, 121 were randomized and 110 were eligible for efficacy analysis (57 decolonization bundle group, 53 control group). Overall, 90% of evaluable participants had methicillin-susceptible SA strains. Eradication of SA at all body sites was achieved for 41 of 57 participants (71.9%) in the decolonization bundle group and for 13 of 53 participants (24.5%) in the control group, a difference of 47.4% (95% confidence interval [CI], 29.1%-65.7%; P<.0001).Conclusion An outpatient preoperative antiseptic decolonization bundle aimed at 4 body sites was significantly more effective in eradicating SA than the usual disinfectant showers (ie, the control).Trial Registration ClinicalTrials.gov identifier: NCT02182115

Original languageEnglish (US)
Pages (from-to)1049-1057
Number of pages9
JournalInfection Control and Hospital Epidemiology
Volume39
Issue number9
DOIs
StatePublished - Sep 1 2018

PubMed: MeSH publication types

  • Comparative Study
  • Journal Article
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

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