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| Sponsor: | Los Angeles Biomedical Research Institute |
|---|---|
| Collaborator: |
Kaiser Permanente |
| Information provided by (Responsible Party): | Los Angeles Biomedical Research Institute |
| ClinicalTrials.gov Identifier: | NCT00560599 |
Purpose
This clinical trial tests the hypotheses that 1) body decolonization of patients with recurrent community-associated (CA) MRSA infections and their household members and 2) environmental decolonization of the patients' households will significantly reduce the likelihood of recurrent CA-MRSA infection.
| Condition | Intervention | Phase |
|---|---|---|
|
Methicillin Resistant Staphylococcus Aureus Skin Infections |
Drug: mupirocin and chlorhexidine Behavioral: household cleaning and disinfection Drug: mupirocin, chlorhexidine, & household cleaning/disinfection |
Phase III |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Endpoint Classification: Efficacy Study Intervention Model: Factorial Assignment Masking: Open Label Primary Purpose: Prevention |
| Official Title: | A 2X2 Phase III Open-label Clinical Trial of Therapy for Patients With Recurrent Methicillin Resistant Staphylococcus Aureus Infections: Topical Nasal & Body Decolonization and/or Environmental Decontamination vs. Standard of Care |
| Estimated Enrollment: | 350 |
| Study Start Date: | April 2007 |
| Estimated Study Completion Date: | December 2011 |
| Primary Completion Date: | July 2010 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
No Intervention: 1: Standard of care
Standard of care (no body decolonization regimen) and Standard of care (no environmental decolonization regimen)
|
|
|
Experimental: 2: Body decolonization regimen
Body decolonization regimen and Standard of care (no environmental decolonization regimen)
|
Drug: mupirocin and chlorhexidine
Mupirocin (Bactroban Nasal): twice a day for 7 days, apply one pea-sized amount of Bactroban Nasal ointment directly into one nostril and another pea-sized amount for the other nostril. Chlorhexidine (Hibiclens): once a day for 14 days, rinse body with chlorhexidine. |
|
Experimental: 3 Environmental decolonization regimen
Standard of care (no body decolonization regimen) and Environmental decolonization regimen
|
Behavioral: household cleaning and disinfection
Environmental cleaning with topical ethanol and laundering of clothes and linen.
|
|
Experimental: 4 Body and Environmental decolonization regimens
Body decolonization regimen and Environmental decolonization regimen
|
Drug: mupirocin, chlorhexidine, & household cleaning/disinfection
Mupirocin (Bactroban Nasal): twice a day for 7 days, apply one pea-sized amount of Bactroban Nasal ointment directly into one nostril and another pea-sized amount for the other nostril. Chlorhexidine (Hibiclens): once a day for 14 days, rinse body with chlorhexidine. Environmental cleaning with topical ethanol and laundering of clothes and linen. |
Staphylococcus aureus is a ubiquitous pathogen, and causes infections of the skin, lung, bloodstream, and other body parts. Over the past decade,community-acquired methicillin resistant S. aureus (CA-MRSA) infections, which were previously extremely rare, are occurring commonly worldwide. CA-MRSA is the most common cause of skin infection in many locales in the U.S., including Southern California.
CA-MRSA strains are notable for their ability to spread in closed settings and cause recurrent infections among healthy persons. Management of recurrent CA-MRSA infection is challenging and optimal prevention strategies are undefined. Many experts recommend topical agents that decontaminate the body and/or anterior nares. Others suggest environmental decontamination to help control recurrences or transmission within households. However, there are no data that quantify the efficacy and safety of these approaches.
We will conduct a multi-center clinical trial to compare the efficacy and safety of body and environmental decolonization regimens in the prevention of CA-MRSA infection. This trial is being conducted at Kaiser Permanente Southern California (KPSC) sites among KPSC enrollees.
The study population will comprise of persons suffering from recurrent CA-MRSA infection. Household members of this "index subject" will also be offered the chance to enroll in the study. For this clinical trial, all subjects will be randomized in a 2 x 2 design to test: 1) chlorhexidine body washes and nasal mupirocin ointment vs. usual care, and 2) environmental cleansing with ethanol spray and aggressive laundering vs. no environmental cleansing. Household members, should they consent, will also be enrolled into the study into the same treatment arm as "index subjects". We will also perform selected secondary analyses, including studying the efficacy of the interventions at preventing infections in household members. Additionally, we will examine strain relatedness of colonizing and infecting CA-MRSA strains to better understand colonization dynamics within households.
Eligibility| Ages Eligible for Study: | 1 Month and older |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
A. Be associated with mutually exclusive patient encounters that are separated by at least 21 days. The encounters include: outpatient visits to primary care provider; outpatient visits to emergency departments or urgent care facilities; inpatient hospitalizations (admission date is considered the encounter date)
AND
Each patient encounter defined in section A is associated with EITHER:
B. EITHER receipt of a prescription (or course) of antibiotics for a clinical infection.
OR
C. A visit to an outpatient setting (including primary care provider visits, emergency department visits, phone consultations, and urgent care visits) for a skin or skin structure infection.
Exclusion Criteria:
Contacts and Locations| United States, California | |
| Kaiser Permanente, Anaheim | |
| Anaheim, California, United States, 92807 | |
| Kaiser Permanente, Bellflower | |
| Bellflower, California, United States, 90706 | |
| Kaiser Permanente, Harbor City | |
| Harbor City, California, United States, 90710 | |
| Kaiser Permanente, Irvine | |
| Irvine, California, United States, 92618 | |
| Kaiser Permanente, Panorama City | |
| Panorama City, California, United States, 91402 | |
| Kaiser Permanente, West LA | |
| West Los Angeles, California, United States, 90034 | |
| Principal Investigator: | Jared Spotkov, M.D. | Kaiser Permanente Southern California |
| Study Chair: | Loren Miller, M.D., M.P.H. | Harbor-UCLA Medical Center (LABiomed) |
More Information
| Responsible Party: | Los Angeles Biomedical Research Institute |
| ClinicalTrials.gov Identifier: | NCT00560599 History of Changes |
| Other Study ID Numbers: | 12550-01, KPSC IRB: 4714, CDC: 1U01CI000384-01 |
| Study First Received: | November 16, 2007 |
| Last Updated: | October 5, 2011 |
| Health Authority: | United States: Institutional Review Board; United States: Federal Government |
|
MRSA Methicillin Resistant Staphylococcus aureus Staphylococcus aureus |
Skin Infections Body Decolonization Environmental Decolonization |
|
Skin Diseases, Infectious Staphylococcal Infections Infection Skin Diseases Gram-Positive Bacterial Infections Bacterial Infections Chlorhexidine Chlorhexidine gluconate Methicillin Mupirocin |
Anti-Infective Agents, Local Anti-Infective Agents Therapeutic Uses Pharmacologic Actions Disinfectants Dermatologic Agents Anti-Bacterial Agents Protein Synthesis Inhibitors Enzyme Inhibitors Molecular Mechanisms of Pharmacological Action |