Department of Community and Public Health, Johns Hopkins University School of Nursing, Baltimore, MD.
Department of Community and Public Health, Johns Hopkins University School of Nursing, Baltimore, MD.
Am J Infect Control. 2017 Oct 1;45(10):1074-1080. doi: 10.1016/j.ajic.2017.05.010. Epub 2017 Jul 3.
People living with HIV (PLWH) have a higher prevalence of methicillin-resistant Staphylococcus aureus (MRSA) colonization and likelihood of recurrent infection than the general population. Simultaneously treating MRSA-colonized household members may improve success with MRSA decolonization strategies. This article describes a pilot trial testing household-level MRSA decolonization and documents methodologic and pragmatic challenges of this approach.
We conducted a randomized controlled trial of individual versus individual-plus-household MRSA decolonization to reduce recurrent MRSA. PLWH with a history of MRSA who are patients of an urban HIV clinic received a standard MRSA decolonization regimen. MRSA colonization at 6 months was the primary outcome.
One hundred sixty-six patients were referred for MRSA screening; 77 (46%) enrolled. Of those, 28 (36%) were colonized with MRSA and identified risk factors consistent with the published literature. Eighteen were randomized and 13 households completed the study.
This is the first study to report on a household-level MRSA decolonization among PLWH. Challenges included provider referral, HIV stigma, confidentiality concerns over enrolling households, and dynamic living situations. Although simultaneous household MRSA decolonization may reduce recolonization, recruitment and retention challenges specific to PLWH limit the ability to conduct household-level research. Efforts to minimize these barriers are needed to inform evidence-based practice.
与普通人群相比，HIV 感染者（PLWH）耐甲氧西林金黄色葡萄球菌（MRSA）定植和复发性感染的发生率更高。同时对 MRSA 定植的家庭成员进行治疗可能会提高 MRSA 去定植策略的成功率。本文描述了一项试点试验，该试验测试了家庭层面的 MRSA 去定植，并记录了这种方法的方法学和实际挑战。
我们进行了一项个体与个体加家庭 MRSA 去定植以减少复发性 MRSA 的随机对照试验。曾患有 MRSA 的 HIV 门诊患者接受了标准的 MRSA 去定植方案。6 个月时的 MRSA 定植是主要结局。
有 166 名患者被转介进行 MRSA 筛查；有 77 名（46%）患者入组。其中 28 名（36%）患者 MRSA 定植，确定了与已发表文献一致的危险因素。18 名患者被随机分组，13 个家庭完成了研究。
这是第一项报告 PLWH 家庭层面 MRSA 去定植的研究。面临的挑战包括提供者转介、HIV 污名、对家庭入组的保密性担忧，以及动态的生活环境。尽管同时对家庭进行 MRSA 去定植可能会减少再定植，但 PLWH 特有的招募和保留挑战限制了进行家庭层面研究的能力。需要努力减少这些障碍，为循证实践提供信息。
