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Chlorhexidine Gluconate Reduces Transmission of Methicillin-Resistant Staphylococcus aureus USA300 among Marine Recruits

Published online by Cambridge University Press:  02 January 2015

Timothy J. Whitman ,
Carey D. Schlett ,
Greg A. Grandits ,
Eugene V. Millar ,
Katrin Mende ,
Duane R. Hospenthal ,
Patrick R. Murray  and
David R. Tribble
Timothy J. Whitman*
Affiliation:
Infectious Diseases Service, Walter Reed National Military Medical Center, Bethesda, Maryland
Carey D. Schlett
Affiliation:
Infectious Disease Clinical Research Program, Uniformed Services University, Bethesda, Maryland
Greg A. Grandits
Affiliation:
Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota
Eugene V. Millar
Affiliation:
Infectious Disease Clinical Research Program, Uniformed Services University, Bethesda, Maryland
Katrin Mende
Affiliation:
Infectious Disease Clinical Research Program, Uniformed Services University, Bethesda, Maryland San Antonio Military Medical Center, Fort Sam Houston, Texas
Duane R. Hospenthal
Affiliation:
San Antonio Military Medical Center, Fort Sam Houston, Texas
Patrick R. Murray
Affiliation:
National Institutes of Health, Bethesda, Maryland
David R. Tribble
Affiliation:
Infectious Disease Clinical Research Program, Uniformed Services University, Bethesda, Maryland
*
Department of Infectious Diseases, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda MD 20889 (timothy.whitman@med.navy.mil)
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Abstract

Background.

Methicillin-resistant Staphylococcus aureus (MRSA) pulsed-field type (PFT) USA300 causes skin and soft tissue infections in military recruits and invasive disease in hospitals. Chlorhexidine gluconate (CHG) is used to reduce MRSA colonization and infection. The impact of CHG on the molecular epidemiology of MRSA is not known.

Objective.

To evaluate the impact of 2% CHG—impregnated cloths on the molecular epidemiology of MRSA colonization.

Design.

Cluster-randomized, double-blind, controlled trial.

Setting.

Marine Officer Candidate School, Quantico, Virginia, in 2007.

Participants.

Military recruits.

Intervention.

Thrice-weekly application of CHG-impregnated or control (Comfort Bath; Sage) cloths over the entire body.

Measurements.

Baseline and serial (every 2 weeks) nasal and/or axillary swab samples were assessed for MRSA colonization. Molecular analysis was performed with pulsed-field gel electrophoresis.

Results.

During training, 77 subjects (4.9%) acquired MRSA, 26 (3.3%) in the CHG group and 51 (6.5%) in the control group (P = .004). When analyzed for PFT, 24 subjects (3.1%) in the control group but only 6 subjects (0.8%) in the CHG group (P = .001) had USA300. Of the 167 colonizing isolates recovered from 77 subjects, 99 were recovered from the control group, including USA300 (40.4%), USA800 (38.4%), USA1000 (12.1%), and USA100 (6.1%), and 68 were recovered from the CHG group, including USA800 (51.5%), USA100 (23.5%), and USA300 (13.2%).

Conclusions.

CHG decreased the transmission of MRSA—more specifically, USA300—among military recruits. In addition, USA300 and USA800 outcompeted other MRSA PFTs at incident colonization. Future studies should evaluate the broad-based use of CHG to decrease transmission of USA300 in hospital settings.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 8 , August 2012 , pp. 809 - 816
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

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References

1.Ellis, MW, Hospenthal, DR, Dooley, DP, Gray, PJ, Murray, CK. Natural history of community-acquired methicillin-resistant Staphylococcus aureus colonization and infection in soldiers. Clin Infect Dis 2004;39(7): 971–979.Google Scholar
2.Fridkin, SK, Hageman, JC, Morrison, M, et al. Methicillin-resistant Staphylococcus aureus disease in three communities. N Engl J Med 2005;352(14): 1436–1444.Google Scholar
3.Kravitz, GR, Dries, DJ, Peterson, ML, Schlievert, PM. Purpura fulminans due to Staphylococcus aureus. Clin Infect Dis 2005;40(7):941–947.Google Scholar
4.Gorwitz, RJ, Jernigan, DB, Powers, JH, Jernigan, JA, Participants in the CDC Convened Experts' Meeting on Management of MRSA in the Community. Strategies for Clinical Management of MRSA in the Community: Summary of an Experts' Meeting Convened by the Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 2006. http://www.cdc.gov/ncidod/dhqp/ar_mrsa_ca.html.Google Scholar
5.Whitman, TJ, Herlihy, RK, Schlett, CD, et al. Chlorhexidine-impregnated cloths to prevent skin and soft-tissue infection in Marine recruits: a cluster-randomized, double-blind, controlled effectiveness trial. Infect Control Hosp Epidemiol 2010;31(12): 1207–1215.Google Scholar
6.McDougal, LK, Steward, CD, Killgore, GE, Chaitram, JM, McAllister, SK, Tenover, FC. Pulsed-field gel electrophoresis typing of oxacillin-resistant Staphylococcus aureus isolates from the United States: establishing a national database. J Clin Microbiol 2003;41(11): 5113–5120.CrossRefGoogle ScholarPubMed
7.Gorwitz, RJ, Kruszon-Moran, D, McAllister, SK, et al. Changes in the prevalence of nasal colonization with Staphylococcus aureus in the United States, 2001-2004. J Infect Dis 2008;197(9): 1226–1234.Google Scholar
8.Tenover, FC, McAllister, S, Fosheim, G, et al. Characterization of Staphylococcus aureus isolates from nasal cultures collected from individuals in the United States in 2001 to 2004. J Clin Microbiol 2008;46(9): 2837–2841.CrossRefGoogle ScholarPubMed
9.Blanc, DS, Petignat, C, Wenger, A, et al. Changing molecular epidemiology of methicillin-resistant Staphylococcus aureus in a small geographic area over an eight-year period. J Clin Microbiol 2007;45(11):3729–3736.Google Scholar
10.King, MD, Humphrey, BJ, Wang, YF, Kourbatova, EV, Ray, SM, Blumberg, HM. Emergence of community-acquired methicillin-resistant Staphylococcus aureus USA 300 clone as the predominant cause of skin and soft-tissue infections. Ann Intern Med 2006;144(5): 309–317.CrossRefGoogle ScholarPubMed
11.Ellis, MW, Griffith, ME, Jorgensen, JH, Hospenthal, DR, Mende, K, Patterson, JE. Presence and molecular epidemiology of virulence factors in methicillin-resistant Staphylococcus aureus strains colonizing and infecting soldiers. J Clin Microbiol 2009;47(4):940–945.Google Scholar
12.Tenover, FC, Tickler, IA, Goering, RV, Kreiswirth, BN, Mediavilla, JR, Persing, DH. Characterization of nasal and blood culture isolates of methicillin-resistant Staphylococcus aureus from patients in United States hospitals. Antimicrob Agents Chemother 2012;56(3): 1324–1330.Google Scholar
13.Bannerman, T. Staphylococci and other catalase-positive cocci that grow aerobically. In: Murray, PR, Baron, EJ, Jorgensen, JH, Pfaller, MA, Yolken, RH, eds. Manual of Clinical Microbiology. 8 th ed. Washington, DC: ASM, 2003:384–404.Google Scholar
14.Tenover, FC, Arbeit, RD, Goering, RV, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33(9): 2233–2239.CrossRefGoogle ScholarPubMed
15.Murray, CK, Holmes, RL, Ellis, MW, et al. Twenty-five year epidemiology of invasive methicillin-resistant Staphylococcus aureus (MRSA) isolates recovered at a burn center. Burns 2009;35(8):1112–1117.Google Scholar
16.Clinical and Laboratory Standards Institute. Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria that Grow Aerobically: Approved Standard; Seventh Edition. Wayne, PA: CLSI; 2006. CLSI document M7-A7;26(2).Google Scholar
17.Cookson, BD, Bolton, MC, Platt, JH. Chlorhexidine resistance in methicillin-resistant Staphylococcus aureus or just an elevated MIC? an in vitro and in vivo assessment. Antimicrob Agents Chemother 1991;35(10): 1997–2002.Google Scholar
18.Noguchi, N, Hase, M, Kitta, M, Sasatsu, M, Deguchi, K, Kono, M. Antiseptic susceptibility and distribution of antiseptic-resistance genes in methicillin-resistant Staphylococcus aureus. FEMS Microbiol Lett 1999;172(2): 247–253.Google Scholar
19.Austin, PC. A comparison of the statistical power of different methods for the analysis of cluster randomization trials with binary outcomes. Stat Med 2007;26(19): 3550–3565.Google Scholar
20.Popovich, KJ, Weinstein, RA, Hota, B. Are community-associated methicillin-resistant Staphylococcus aureus (MRSA) strains replacing traditional nosocomial MRSA strains? Clin Infect Dis 2008;46(6): 787–794.Google Scholar
21.Seybold, U, Kourbatova, EV, Johnson, JG, et al. Emergence of community-associated methicillin-resistant Staphylococcus aureus USA300 genotype as a major cause of health care-associated blood stream infections. Clin Infect Dis 2006;42(5): 647–656.CrossRefGoogle Scholar
22.D'Agata, EM, Webb, GRHorn, MA, Moellering, RC Jr, Ruan, S. Modeling the invasion of community-acquired methicillin-resistant Staphylococcus aureus into hospitals. Clin Infect Dis 2009;48(3): 274–284.Google Scholar
23.Sivaraman, K, Venkataraman, N, Cole, AM. Staphylococcus aureus nasal carriage and its contributing factors. Future Microbiol 2009;4(8):999–1008.CrossRefGoogle ScholarPubMed
24.Diep, BA, Otto, M. The role of virulence determinants in community-associated MRSA pathogenesis. Trends Microbiol 2008;16(8):361–369.Google Scholar
25.van Belkum, A, Melles, DC, Nouwen, J, et al. Co-evolutionary aspects of human colonisation and infection by Staphylococcus aureus. Infect Genet Evol 2009;9(1):32–47.CrossRefGoogle ScholarPubMed
26.Moran, GJ, Krishnadasan, A, Gorwitz, RJ, et al. Methicillin-resistant S. aureus infections among patients in the emergency department. N Engl J Med 2006;355(7): 666–674.CrossRefGoogle ScholarPubMed
27.Milstone, AM, Passaretti, CL, Perl, TM. Chlorhexidine: expanding the armamentarium for infection control and prevention. Clin Infect Dis 2008;46(2): 274–281.Google Scholar
28.Bleasdale, SC, Trick, WE, Gonzalez, IM, Lyles, RD, Hayden, MK, Weinstein, RA. Effectiveness of Chlorhexidine bathing to reduce catheter-associated bloodstream infections in medical intensive care unit patients. Arch Intern Med 2007;167(19): 2073–2079.Google Scholar
29.Popovich, KJ, Hota, B, Hayes, R, Weinstein, RA, Hayden, MK. Effectiveness of routine patient cleansing with Chlorhexidine gluconate for infection prevention in the medical intensive care unit. Infect Control Hosp Epidemiol 2009;30(10): 959–963.CrossRefGoogle ScholarPubMed
30.Climo, MW, Sepkowitz, KA, Zuccotti, G, et al. The effect of daily bathing with Chlorhexidine on the acquisition of methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococ-cus, and healthcare-associated bloodstream infections: results of a quasi-experimental multicenter trial. Crif Care Med 2009;37(6):1858–1865.CrossRefGoogle Scholar
31.Wendt, C, Schinke, S, Wurttemberger, M, Oberdorfer, K, Bock-Hensley, O, von Baum, H. Value of whole-body washing with Chlorhexidine for the eradication of methicillin-resistant Staphylococcus aureus: a randomized, placebo-controlled, double-blind clinical trial. Infect Control Hosp Epidemiol 2007;28(9): 1036–1043.Google Scholar
32.Wang, JT, Sheng, WH, Wang, JL, et al. Longitudinal analysis of Chlorhexidine susceptibilities of nosocomial methicillin-resistant Staphylococcus aureus isolates at a teaching hospital in Taiwan. J Antimicrob Chemother 2008;62(3): 514–517.Google Scholar
33.Noguchi, N, Suwa, J, Narui, K, et al. Susceptibilities to antiseptic agents and distribution of antiseptic-resistance genes qacA/B and smr of methicillin-resistant Staphylococcus aureus isolated in Asia during 1998 and 1999. J Med Microbiol 2005;54(6): 557–565.Google Scholar
34.Creech, CB, Saye, E, McKenna, BD, et al. One-year surveillance of methicillin-resistant Staphylococcus aureus nasal colonization and skin and soft tissue infections in collegiate athletes. Arch Pediatr Adolesc Med 2010;164(7): 615–620.Google Scholar
35.Yang, ES, Tan, J, Eells, S, Rieg, G, Tagudar, G, Miller, LG. Body site colonization in patients with community-associated methicillin-resistant Staphylococcus aureus and other types of S. aureus skin infections. Clin Microbiol Infect 2010;16(5): 425–431.Google Scholar