MRSA Clinical Trial
Official title:
Stop Community MRSA Colonization Among Patients (SUSTAIN)
This research is being done to learn more about an approach to remove Methicillin resistant
Staphylococcus aureus (MRSA) in patients who are carriers of the bacteria in outpatient
settings and among their household members and sexual partners.
MRSA is a type of bacteria or germ that can cause bad infections of the skin that can make
people very sick. The bacteria have been seen in a high number of persons in the Baltimore
area and in hospitals throughout the country. MRSA can be spread from person to person,
particularly in homes and among family members and sexual partners.
There are three things the investigators hope to learn from this research study:
First, the investigators want to find a way to prevent MRSA infections in outpatient
settings. By asking questions, the investigators want to look at the things that may increase
the risk of having this type of bacteria in you and your family members.
Second, the investigators have soaps and oral rinses (Chlorhexidine) and medications
(antibiotics; Mupirocin ointment) that have been shown to be effective at removing MRSA. The
investigators want to determine if these antibiotics and soaps are best used for everyone in
the household or only the individual with known MRSA.
Third, as the investigators, we want to learn more about the bacteria by looking at it on the
inside. The investigators will do laboratory tests on samples we collect, to learn how MRSA
bacteria grow, reproduce and how it develops to behave differently than other types of MRSA
bacteria.
Methicillin resistant Staphylococcus aureus (MRSA) kills more patients in the United States
(U.S.) than Acquired Immunodeficiency Syndrome (AIDS). Further, persons living with Human
Immunodeficiency Virus (HIV) experience MRSA infection at significantly higher rates than the
general population (12.3/ 1000 person years compared to 1 to 2/1000 person years) and MRSA
remains a substantial reason for hospital admission among this patient population.
Colonization with Staphylococcus aureus is a major risk factor for infection in persons
living with HIV and AIDS (PLWHA) and eradication of MRSA colonization reduces the occurrence
of subsequent infection in patients. Household contacts with MRSA colonization increase
failure rates of decolonization. The clinical practice guidelines for MRSA management from
the Infectious Diseases Society of America (IDSA) recommend providing decolonization to
persons with repeated skin and soft tissue infections as well as their household contacts;
however, the guidelines report that evidence is limited in support of this recommendation.
Additionally, these recommendations do not include sexual partners outside the home and there
is mounting evidence of MRSA transmission between sexual partners and sexual networks.
Strategies that reduce the spread of MRSA among people living with HIV/AIDS (PLWHA) are
vitally needed to reduce this disparity.
To assess colonization prevalence among PLWHA, investigators conducted an epidemiologic
evaluation of MRSA among persons within the Johns Hopkins University AIDS Service (JHUAS).
The study included 500 subjects (65.8 % male) along with the sexual partners of 35 subjects.
The MRSA colonization prevalence was 16.8% among subjects and 37% (17/35) in their sexual
partners (unpublished data). These findings demonstrate an exceptional difference in
colonization prevalence in PLWHA compared to the US population and supports the need for
further research to understand decolonization regimens that evaluate outcomes for individual
decolonization only compared to the inclusion household and/or sexual partner interventions.
We propose a randomized controlled trial (RCT) among 100 PLWHA (50 per arm) within the JHUAS
to evaluate an individual versus household/sexual partner decolonization intervention.
The specific aims of the proposed RCT are:
1. To compare a MRSA decolonization protocol for the colonized individual (index) versus
the index plus their household member and/or routine sexual partner(s).
H0: Index plus household/sexual partner(s) decolonization will be associated with a
lower occurrence of MRSA colonization at 6 months after completion of decolonization
protocol.
2. To estimate the intervention effect size and develop an intervention fidelity assessment
plan to scale the intervention into a larger multi-city R01 application.
3. To determine the molecular characteristics and antimicrobial susceptibilities of both
the clinical and colonizing isolates among index patient as well as household members.
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