Methicillin-Resistant Staphylococcus aureus in a Trauma Population: Does Decolonization Prevent Infection?

Principal Investigator: Robert Maxwell, MD
Lead Institution: University of Tennessee Health Science Center at Chattanooga
Participating Sites: Vanderbilt University

Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of infection in both healthcare and community settings and is one of the most common causes of healthcare-associated infections.

In a cohort of 355 consecutive trauma admissions, a previous study indicated a 10.1% incidence of MRSA colonization by nasal swab DNA testing. Of the patients colonized, 33.3% developed an invasive MRSA infection, compared with 6% of the non-colonized patients. The colonized patients who developed invasive MRSA infections required significantly longer days of mechanical ventilation and had higher mortality.

The study hypothesizes that identifying trauma patients colonized with MRSA on admission and employing a decolonization regimen will reduce the incidence of invasive MRSA infection. All trauma patients admitted to the Intensive Care Unit will have nasal swabs performed to determine if they are colonized with MRSA. Patients who are colonized will be randomized to receive either decolonization treatment with Bactorban ointment applied to both nostrils and baths using antibacterial soap or they will have a placebo ointment applied to both nostrils and routine soap baths. Samples of bodily fluids will be obtained to assess for MRSA infections, based on the clinical picture. All MRSA positive cultures will then be tested to identify which strain of MRSA is causing the infection. This will be compared to the initial nasal swab to see if these are the same strain of MRSA.