Management of Skin and Soft Tissue Infections in

Intra-nasal mupirocin to prevent
CA-MRSA SSTI?
• 1° prophylaxis (prospective RCT)
– 134 soldiers with CA-MRSA nasal colonization
– Mupirocin (5d) vs. placebo
– SSTI: 10.6% mupirocin vs. 7.7% placebo
• 2° prophylaxis (retrospective)
– 38 HIV+ with CA-MRSA SSSI and nasal colonization
– Mupirocin vs. no treatment
– Recurrent SSTI: 32% mupirocin vs. 52% no treatment
Ellis et al, AAC ’07. Rahimain et al, ICHE ’07
Daily clindamycin to prevent
recurrent SSTI?
• Subjects: ≥3 abscesses in prior 6 months
• Rx: clindamycin 150 mg QD vs. placebo
• Results: Abscess during Rx period
– 33% (clinda) vs. 81% (placebo); p=0.04
– High recurrence rate after stopping clindamycin
Klempner MS. JAMA 1988.
Chlorhexidine to prevent SA SSTI
• RCT of military recruits to prevent SSTI
• Chlorhexidine wipes vs. placebo 3 x/week
• Results: SSTI rate at 6 weeks
•
% S. aureus carriage
– 9.4% (chlorhexidine) vs. 7.1% (placebo); p=0.13
• Results: S. aureus colonization (45% baseline)
100
90
80
70
60
50
40
30
20
10
0
– 52.6% (chlorhexidine) vs. 67% (placebo)
Whitman TJ. Infect Control Hosp Epidemiol. 2010
Rifampin for eradication of
S. aureus colonization?
Rx period
Control
Rifampin
Cloxacillin
Rifampin and Cloxacillin
0 0.5 1 2 3 4 5 6 7 8 9 10 11 12
Weeks
Wheat J. JID. 1981.
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