Infection Control & Hospital Epidemiology

Original Articles

Effectiveness of Measures to Eradicate Staphylococcus aureus Carriage in Patients with Community-Associated Skin and Soft-Tissue Infections: A Randomized Trial

Stephanie A. Fritza1 c1a, Bernard C. Caminsa2a, Kimberly A. Eisensteina1a2, Joseph M. Fritza2, Emma K. Epplina1a2, Carey-Ann Burnhama1a3, Jonathan Dukesa2 and Gregory A. Storcha1a2

a1 Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri

a2 Department of Medicine, Washington University School of Medicine, St. Louis, Missouri

a3 Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri


Background. Despite a paucity of evidence, decolonization measures are prescribed for outpatients with recurrent Staphylococcus aureus skin and soft-tissue infection (SSTI).

Objective. Compare the effectiveness of 4 regimens for eradicating S. aureus carriage.

Design. Open-label, randomized controlled trial. Colonization status and recurrent SSTI were ascertained at 1 and 4 months.

Setting. Barnes-Jewish and St. Louis Children's Hospitals, St. Louis, Missouri, 2007–2009.

Participants. Three hundred patients with community-onset SSTI and S. aureus colonization in the nares, axilla, or inguinal folds.

Interventions. Participants were randomized to receive no therapeutic intervention (control subjects) or one of three 5-day regimens: 2% mupirocin ointment applied to the nares twice daily, intranasal mupirocin plus daily 4% chlorhexidine body washes, or intranasal mupirocin plus daily dilute bleach water baths.

Results. Among 244 participants with 1-month colonization data, modified intention-to-treat analysis revealed S. aureus eradication in 38% of participants in the education only (control) group, 56% of those in the mupirocin group (P = .03 vs controls), 55% of those in the mupirocin and chlorhexidine group (P = .05), and 63% off those in the mupirocin and bleach group (P = .006). Of 229 participants with 4-month colonization data, eradication rates were 48% in the control group, 56% in the mupirocin only group (P = .40 vs controls), 54% in the mupirocin and chlorhexidine group (P = .51), and 71% in the mupirocin and bleach group (P = .02). At 1 and 4 months, recurrent SSTIs were reported by 20% and 36% of participants, respectively.

Conclusions. An inexpensive regimen of dilute bleach baths, intranasal mupirocin, and hygiene education effectively eradicated S. aureus over a 4-month period. High rates of recurrent SSTI suggest that factors other than endogenous colonization are important determinants of infection.

Trial Registration. identifier: NCT00513799.

(Received March 08 2011)

(Accepted May 02 2011)


c1 660 South Euclid Avenue, Campus Box 8116, St. Louis, MO 63110 (


a   Both authors contributed equally to this work