Aggressive sanitizing at home lowers post-hospital MRSA risk

[February 14, 2019]  By Gene Emery

(Reuters Health) - A six-month program of aggressively washing and sanitizing at home after surgery can lower the risk of developing a potentially-deadly infection for people who harbor the antibiotic-resistant bacterium known as MRSA, a new study suggests.

MRSA, short for methicillin-resistant Staphylococcus aureus, is responsible for over 80,000 invasive and tough-to-treat infections in the U.S. each year. An estimated 1.8 million people are harboring the infection when they're discharged from the hospital annually. It can kill, especially if gets into a person's bloodstream.

The California study of MRSA carriers found that the risk of resistant pneumonia or a wound infection fell by as much as 44 percent if patients complied with an aggressive regimen that included special mouthwash, soap and antibiotic nasal treatment, compared with people who were just given education about preventing a MRSA infection.

"It shows there is a risk and that you can reduce that risk," said Dr. Robert Duncan, chairman of the infection prevention and control program at the Lahey Hospital and Medical Center in Burlington, Massachussetts, who was not involved in the study.

But he cautioned in a phone interview with Reuters Health that the protocol followed by the aggressive-sanitizing group in the study can be daunting.

They had to use nasal mupirocin and chlorhexidine mouthwash twice daily and chlorhexidine soap for a daily bath or shower for five-day blocks twice per month for six months.

While the study, published in the New England Journal of Medicine, may prompt some doctors to be more aggressive in their attempts to prevent a post-hospital MRSA infection, Duncan said, others may worry about whether patients will follow a regimen that is so strict.

Still, he said, ultimately the study is "confirming something many of us in the infectious disease world have been doing for several years" and may encourage other doctors to be aggressive as well. "It shows we have something significant to offer these patients."

More than 2,000 patients found to be carrying MRSA when they entered the hospital were enrolled in the trial.

In the education-only group, discharged patients were given instructions on how to prevent a MRSA illness. And 9.2 percent developed a MRSA infection within one year.

But among volunteers who were put on the sanitizing schedule and given the products to use, 6.3 percent developed infections. The lower infection rate is despite the fact that many didn't fully follow the procedures.

"I think this is terrific news about a very common disease," lead study author Dr. Susan Huang of the University of California, Irvine School of Medicine said in a telephone interview. "It provides a very simple solution that works at the most vulnerable time when people are trying to recover from the hospital and when infections are more likely to cause trouble."

While 0.9 percent in the education-only group died from a MRSA infection, only 0.3 percent succumbed to the bacterium in the group given the special mouthwash, soap and nasal antibiotic.

"If you give (MRSA) an inch to invade the body, it will produce very serious disease a very large fraction of the time," Huang said.

"There are those who didn't use the products at all and there were those who, when the trial ended and we tried to take the products, wouldn't give them up," she noted.

In the latter group, the enthusiasm stems from the fact that a large number of people with MRSA who are hospitalized often have a series of infections, "so they're quite motivated and there's a deep desire on their part to get rid of a pathogen," she said.

The cost for the mouthwash, nasal antibiotic and special soap was about $150-$200, Huang said. But preventing an infection that requires hospitalization saves many thousands of dollars.

The rate of side effects in the aggressive-sanitizing group was 4.2 percent. All the side effects were mild and 40 percent of the volunteers who did have an issue decided to stick with the treatment anyway.

SOURCE: https://bit.ly/2WSBvHC New England Journal of Medicine, online February 13, 2019.

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