RCT on Chlorhexidine Washes for MRSA Eradication

Wendt, C., Schinke, S., Wurttemberger, M., Oberdorfer, K., Bock-Hensley, O., & von Baum, H. (2007). Value of whole-body washing with chlorhexidine for the eradication of methicillin-resistant Staphylococcus aureas: A randomized, placebo-controlled, double-blind clinical trial. Infect Control Hosp Epidemiol, 28: 1036-1043.

Chlorhexidine body washing, in addition to intranasal and oral antmicrobial agents, is frequently prescribed for eradication of MRSA in infected or colonized patients. However, there is insufficient evidence to support its efficacy. This study was the first randomized, placebo-controlled trial to examine the use of chlorhexidine body washes for MRSA eradication.

Participants were provided with 5 one liter bottles of either a 4% chlorhexidine solution or water with 0.1% polysorbate 20 that looked and smelled similar to the chlorhexidine. Bottles were provided by the pharmacist and study invesitagators and participants were blind to treatment. Participants were asked to wash daily for 5 days, using 1 bottle a day with a minimum contact time of 30 seconds.

The overall MRSA eradication rate at 30 days post-treatment was 8% for the treatment (tx) group and 13% for the control group. Samples from the groin area were significantly more negative for the tx group at day 3 post-treatment, but by day 5 the differences were not significant. Persons in the tx group were more likely to develop skin fissures (17.7% vs. 1.8%, p=0.01), more likely to report itching (41.5% vs. 10.9%, p=0.001), and more likely to report burning of the skin (50.0% vs. 9.1%, p<.001).

The study findings suggest that chlorhexidine body washing may reduce MRSA colonization in the short-term, particularly in the groin region, but not permanently eradicate it. Furthermore, the side-effects of the chlorhexidine washing, including development of skin fissures and itching, may foster an environment for MRSA to grow.

Prevalence of MRSA in US Healthcare Facilities

Jarvis, W.R., Schlosser, J., Chinn, R.Y., Tweeten, S.M, & Jackson, M. National prevalence of methicillin-resistant Staphylococcus aureus in inpatients at US health care facilities. Am J Infect Control, 2006; 35(10), 631-637.

This key article describes the prevalence of MRSA infection or colonization in US healthcare facilities. This was a cross-sectional study that evaluated prevalence in every state. The overall prevalence of infection and/or colonization was reported to be 46.3 per 1,000 inpatients. This prevalence is higher than previous findings.

The highest rates of infection were found in Hawaii, New York, Maine, and South Carolina. The lowest rates of infection were found in Western states including Idaho, Montana, North Dakota, Wyoming, South Dakota, Utah, and New Mexico. MRSA infection sites included skin and soft tissue (28%), pulmonary (17%), bloodstream (13%), urinary tract (10%), and surgical site (8%). Of the MRSA isolates, 70% were consistent with hospital-acquired MRSA as opposed to community-acquired MRSA.

Patients in the study were not routinely tested for MRSA colonization and, therefore, prevalence may be higher than reported. Furthermore, due to the cross-sectional design, there was the potential for prevalent case bias which occurs when diseases that last for longer durations are found to be more prevalent by this method of assessment.

Methicillin-Resistant Staphylococcus Aureus

The topic of this blog will be about eradicating methicillin-resistant Staphylococcus aureus (MRSA) (pronounced MER-sah). I spent the summer working at an HIV primary care clinic and was horrified by the number of MRSA infections patients presented with and the resulting pain and frustration. While antibiotics, nasal ointment, and chlorhexidine body washes were frequently prescribed by providers, patients repeatedly developed new absesses infected with MRSA despite compliance with these treatment recommendations. Thus, I think it would be extremely valuable to further explore the the literature on the topic, particularly with regards to clinical practice.