Comparative Effectiveness Study of Home-Based Interventions to Prevent CA-MRSA Infection Recurrence

Abstract

BACKGROUND: Recurrent skin and soft tissue infections (SSTI) caused by Community-Associated Methicillin-Resistant (CA-MRSA) or Methicillin-Sensitive Staphylococcus aureus (CA-MSSA) present treatment challenges. OBJECTIVES: Can an evidence-based intervention (CDC Guidelines, topical decolonization, surface decontamination) reduce SSTI recurrence, mitigate household contamination and transmission, and improve patient-reported outcomes? DESIGN: Randomized trial SETTING: Community settings PARTICIPANTS: Participants (n=186) with confirmed MRSA(+)/MSSA(+) SSTIs and household members. INTERVENTION Community Health Workers/Promotoras conducted home visits and provided participants with instructions, a five-day supply of mupirocin for nasal application, chlorhexidine for body cleansing, and disinfecting wipes for household cleaning (EXP) versus Usual Care (UC). MEASUREMENTS: Primary outcome was six-month SSTI recurrence recorded in electronic health records (EHR). Home visits (months 0/3) and telephone assessments (months 0/1/6) collected self-report data. Surveillance culture swabs (nares, axilla, groin) were obtained from index patients and participating household members. Secondary outcomes included household surface contamination, household member colonization and transmission, quality of life and satisfaction with care. RESULTS: Among patients with SSTIs (n=421), 44.2% were MRSA(+)/MSSA(+); an intent-to-treat analyses (n=186) demonstrated no significant differences in SSTI recurrence (OR: 1.4, 95% CI: 0.51-3.5). Among the enrolled cohort (n=119), there were no significant SSTI recurrence effects (OR=1.14, 95% CI=0.35-3.6). EXP participants showed reduced but non-significant colonization rates. There were no differential reductions in household member transmission or in reductions in proportions of households with >1 contaminated surface. Mupirocin resistance did not increase. No significant improvements for patient-reported outcomes were seen. LIMITATIONS: A lower-than-predicted six-month recurrence rate may have limited the ability to detect effects. CONCLUSION: This intervention did not reduce clinician-reported MRSA/MSSA SSTI recurrence. No differences were observed for household members decolonization or household surfaces decontamination.

Using attendance data for social network analysis of a community-engaged research partnership

“…By multiple objective measures, the CAMP partnership was successful: CAMP1/2 enrolled more than 270 participants, accomplished its scientific and patient-centered aims, and produced a range of publications spanning the phases of translational research [ 18 ] that describe the basic biology and clinical aspects of CA-MRSA in the study population [ 19 – 23 ], the outcome of the CER intervention [ 24 , 25 ] features of the CEnR team science model [ 13 ], and disseminated results to diverse audiences [ 24 – 26 ]. Qualitative measures of collaboration were not collected prospectively in the CAMP1/2 projects.…”