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Targeted Intranasal Mupirocin To Prevent Colonization and Infection by Community-Associated Methicillin-Resistant Staphylococcus aureus Strains in Soldiers: a Cluster Randomized Controlled Trial

Michael W. Ellis,^1* Matthew E. Griffith,¹ David P. Dooley,^1, Joseph C. McLean,¹ James H. Jorgensen,² Jan E. Patterson,^2,3 Kepler A. Davis,^1, Joshua S. Hawley,¹ Jason A. Regules,¹ Robert G. Rivard,¹ Paula J. Gray,⁴ Julia M. Ceremuga,¹ Mary A. DeJoseph,⁵ and Duane R. Hospenthal¹

Departments of Medicine (Infectious Diseases),¹ Preventive Medicine,⁴ Pathology and Area Laboratory Services, Brooke Army Medical Center, Fort Sam Houston, Texas,⁵ Departments of Pathology,² Medicine (Infectious Diseases), University of Texas Health Science Center, San Antonio, Texas³

Received 29 August 2006/ Returned for modification 30 October 2006/ Accepted 30 July 2007

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is an emerging pathogen that primarily manifests as uncomplicated skin and soft tissue infections. We conducted a cluster randomized, double-blind, placebo-controlled trial to determine whether targeted intranasal mupirocin therapy in CA-MRSA-colonized soldiers could prevent infection in the treated individual and prevent new colonization and infection within their study groups. We screened 3,447 soldiers comprising 14 training classes for CA-MRSA colonization from January to December 2005. Each training class was randomized to either the mupirocin or placebo study group, and the participants identified as CA-MRSA colonized were treated with either mupirocin or placebo. All participants underwent repeat screening after 8 to 10 weeks and were monitored for 16 weeks for development of infection. Of 3,447 participants screened, 134 (3.9%) were initially colonized with CA-MRSA. Five of 65 (7.7%; 95% confidence interval [95% CI], 4.0% to 11.4%) placebo-treated participants and 7 of 66 (10.6%; 95% CI, 7.9% to 13.3%) mupirocin-treated participants developed infections; the difference in the infection rate of the placebo- and mupirocin-treated groups was –2.9% (95% CI, –7.5% to 1.7%). Of those not initially colonized with CA-MRSA, 63 of 1,459 (4.3%; 95% CI, 2.7% to 5.9%) of the placebo group and 56 of 1,607 (3.5%; 95% CI, 2.6% to 5.2%) of the mupirocin group developed infections; the difference in the infection rate of the placebo and mupirocin groups was 0.8% (95% CI, –1.0% to 2.7%). Of 3,447 participants, 3,066 (89%) were available for the second sampling and completed follow-up. New CA-MRSA colonization occurred in 24 of 1,459 (1.6%; 95% CI, 0.05% to 2.8%) of the placebo group participants and 23 of 1,607 (1.4%; 95% CI, 0.05% to 2.3%) of the mupirocin group participants; the difference in the infection rate of the placebo and mupirocin groups was 0.2% (95% CI, –1.3% to 1.7%). Despite CA-MRSA eradication in colonized participants, this study showed no decrease in infections in either the mupirocin-treated individuals or within their study group. Furthermore, CA-MRSA eradication did not prevent new colonization within the study group.

Published ahead of print on 6 August 2007.

Present address: Audie L. Murphy Veterans Administration Hospital, San Antonio, TX.

Present address: Department of Medicine (Infectious Diseases), D. D. Eisenhower Army Medical Center, Fort Gordon, GA.

This article has been cited by other articles:

• Gorwitz, R., Fridkin, S. K., Workowski, K. A. (2008). More Challenges in the Prevention and Management of Community-Associated, Methicillin-Resistant Staphylococcus aureus Skin Disease. ANN INTERN MED 148: 310-312 [Full Text]