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Chlorhexidine Gluconate Reduces Transmission of Methicillin-Resistant Staphylococcus aureus USA300 among Marine Recruits

Published online by Cambridge University Press:  02 January 2015

Timothy J. Whitman ,
Carey D. Schlett ,
Greg A. Grandits ,
Eugene V. Millar ,
Katrin Mende ,
Duane R. Hospenthal ,
Patrick R. Murray  and
David R. Tribble
Timothy J. Whitman*
Affiliation:
Infectious Diseases Service, Walter Reed National Military Medical Center, Bethesda, Maryland
Carey D. Schlett
Affiliation:
Infectious Disease Clinical Research Program, Uniformed Services University, Bethesda, Maryland
Greg A. Grandits
Affiliation:
Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota
Eugene V. Millar
Affiliation:
Infectious Disease Clinical Research Program, Uniformed Services University, Bethesda, Maryland
Katrin Mende
Affiliation:
Infectious Disease Clinical Research Program, Uniformed Services University, Bethesda, Maryland San Antonio Military Medical Center, Fort Sam Houston, Texas
Duane R. Hospenthal
Affiliation:
San Antonio Military Medical Center, Fort Sam Houston, Texas
Patrick R. Murray
Affiliation:
National Institutes of Health, Bethesda, Maryland
David R. Tribble
Affiliation:
Infectious Disease Clinical Research Program, Uniformed Services University, Bethesda, Maryland
*
Department of Infectious Diseases, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda MD 20889 (timothy.whitman@med.navy.mil)
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Abstract

Background.

Methicillin-resistant Staphylococcus aureus (MRSA) pulsed-field type (PFT) USA300 causes skin and soft tissue infections in military recruits and invasive disease in hospitals. Chlorhexidine gluconate (CHG) is used to reduce MRSA colonization and infection. The impact of CHG on the molecular epidemiology of MRSA is not known.

Objective.

To evaluate the impact of 2% CHG—impregnated cloths on the molecular epidemiology of MRSA colonization.

Design.

Cluster-randomized, double-blind, controlled trial.

Setting.

Marine Officer Candidate School, Quantico, Virginia, in 2007.

Participants.

Military recruits.

Intervention.

Thrice-weekly application of CHG-impregnated or control (Comfort Bath; Sage) cloths over the entire body.

Measurements.

Baseline and serial (every 2 weeks) nasal and/or axillary swab samples were assessed for MRSA colonization. Molecular analysis was performed with pulsed-field gel electrophoresis.

Results.

During training, 77 subjects (4.9%) acquired MRSA, 26 (3.3%) in the CHG group and 51 (6.5%) in the control group (P = .004). When analyzed for PFT, 24 subjects (3.1%) in the control group but only 6 subjects (0.8%) in the CHG group (P = .001) had USA300. Of the 167 colonizing isolates recovered from 77 subjects, 99 were recovered from the control group, including USA300 (40.4%), USA800 (38.4%), USA1000 (12.1%), and USA100 (6.1%), and 68 were recovered from the CHG group, including USA800 (51.5%), USA100 (23.5%), and USA300 (13.2%).

Conclusions.

CHG decreased the transmission of MRSA—more specifically, USA300—among military recruits. In addition, USA300 and USA800 outcompeted other MRSA PFTs at incident colonization. Future studies should evaluate the broad-based use of CHG to decrease transmission of USA300 in hospital settings.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 8 , August 2012 , pp. 809 - 816
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

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