Prevention of Recurrent Staphylococcal Skin Infections

Abstract

Staphylococcus aureus infections pose a significant health burden. The emergence of community-associated methicillin-resistant S aureus has resulted in an epidemic of skin and soft tissue infections (SSTI), and many patients experience recurrent SSTI. As S aureus colonization is associated with subsequent infection, decolonization is recommended for patients with recurrent SSTI or in settings of ongoing transmission. S aureus infections often cluster within households, and asymptomatic carriers serve as reservoirs for transmission; therefore, a household approach to decolonization is more effective than measures performed by individuals alone. Novel strategies for the prevention of recurrent SSTI are needed.

Keywords: Decolonization; MRSA; Pediatrics; Prevention; Skin infection; Staphylococcal vaccine; Staphylococcus aureus.

Figure 1. Recommended approach to prevention of recurrent staphylococcal SSTI

For all patients with S. aureus SSTI, we recommend optimizing hygiene measures. For those experiencing recurrent SSTI, or for households in which multiple members have experienced S. aureus infection, we recommend decolonization with a regimen that includes the application of an intranasal antibiotic (twice daily for 5 days) and daily antimicrobial body washes (performed daily for 5 days; for individuals with sensitive skin, these washes may be performed every other day for 7–10 days). These measures should be performed by all household members and may be considered for other close contacts on a case-by-case basis. Patients and their household contacts should change their bedding at the onset and again at the completion of the decolonization regimen and towels should be changed daily during the 5-day protocol. For individuals experiencing recurrent SSTI after the optimization of personal and household hygiene measures and the performance of decolonization by all household members, clinicians may consider prescribing a three-month regimen of periodic decolonization, in which an intranasal antibiotic is applied to the anterior nares twice daily for five consecutive days each month and antimicrobial body washes are performed two to three times each week.