TY - JOUR
T1 - Randomized clinical trial
T2 - Long-term Staphylococcus aureus decolonization in patients on home parenteral nutrition
AU - Gompelman, Michelle
AU - Wezendonk, Guus T. J.
AU - Wouters, Yannick
AU - Beurskens-Meijerink, Judith
AU - Fragkos, Konstantinos C.
AU - Rahman, Farooq Z.
AU - Coolen, Jordy P. M.
AU - van Weerdenburg, Ingrid J. M.
AU - Wertheim, Heiman F. L.
AU - Kievit, Wietske
AU - Akkermans, Reinier P.
AU - Serlie, Mireille J.
AU - Bleeker-Rovers, Chantal P.
AU - Wanten, Geert J. A.
N1 - Funding Information: This trial was supported by a governmental grant ( ZonMw ) with grant number 848015009 . Additionally, the study medication that the participant's own insurance company did not reimburse was provided by Innovation fund Zorgverzekeraars (Reference 3536). The funding parties had no direct role in the study design, data collection, and analysis, or interpretation of the data. The funding parties did not contribute to the manuscript preparation and were not involved in publication. Publisher Copyright: © 2023 The Author(s)
PY - 2023/5/1
Y1 - 2023/5/1
N2 - Background & aims: Staphylococcus aureus decolonization has proven successful in prevention of S. aureus infections and is a key strategy to maintain venous access and avoid hospitalization in patients receiving home parenteral nutrition (HPN). We aimed to determine the most effective and safe long-term S. aureus decolonization regimen. Methods: A randomized, open-label, multicenter clinical trial was conducted. Adult intestinal failure patients with HPN support and carrying S. aureus were randomly assigned to a ‘continuous suppression’ (CS) strategy, a repeated chronic topical antibiotic treatment or a ‘search and destroy’ (SD) strategy, a short and systemic antibiotic treatment. Primary outcome was the proportion of patients in whom S. aureus was totally eradicated during a 1-year period. Secondary outcomes included risk factors for decolonization failure and S. aureus infections, antimicrobial resistance, adverse events, patient compliance and cost-effectivity. Results: 63 participants were included (CS 31; SD 32). The mean 1-year S. aureus decolonization rate was 61% (95% CI 44, 75) for the CS group and 39% (95% CI 25, 56) for the SD group with an OR of 2.38 (95% CI 0.92, 6.11, P = 0.07). More adverse effects occurred in the SD group (P = 0.01). Predictors for eradication failure were a S. aureus positive caregiver and presence of a (gastro)enterostomy. Conclusion: We did not demonstrate an increased efficacy of a short and systemic S. aureus decolonization strategy over a continuous topical suppression treatment. The latter may be the best option for HPN patients as it achieved a higher long-term decolonization rate and was well-tolerated (NCT03173053).
AB - Background & aims: Staphylococcus aureus decolonization has proven successful in prevention of S. aureus infections and is a key strategy to maintain venous access and avoid hospitalization in patients receiving home parenteral nutrition (HPN). We aimed to determine the most effective and safe long-term S. aureus decolonization regimen. Methods: A randomized, open-label, multicenter clinical trial was conducted. Adult intestinal failure patients with HPN support and carrying S. aureus were randomly assigned to a ‘continuous suppression’ (CS) strategy, a repeated chronic topical antibiotic treatment or a ‘search and destroy’ (SD) strategy, a short and systemic antibiotic treatment. Primary outcome was the proportion of patients in whom S. aureus was totally eradicated during a 1-year period. Secondary outcomes included risk factors for decolonization failure and S. aureus infections, antimicrobial resistance, adverse events, patient compliance and cost-effectivity. Results: 63 participants were included (CS 31; SD 32). The mean 1-year S. aureus decolonization rate was 61% (95% CI 44, 75) for the CS group and 39% (95% CI 25, 56) for the SD group with an OR of 2.38 (95% CI 0.92, 6.11, P = 0.07). More adverse effects occurred in the SD group (P = 0.01). Predictors for eradication failure were a S. aureus positive caregiver and presence of a (gastro)enterostomy. Conclusion: We did not demonstrate an increased efficacy of a short and systemic S. aureus decolonization strategy over a continuous topical suppression treatment. The latter may be the best option for HPN patients as it achieved a higher long-term decolonization rate and was well-tolerated (NCT03173053).
KW - Central venous access device
KW - Central venous catheter
KW - Decolonization
KW - Home parenteral nutrition
KW - S. aureus carriage
KW - Staphylococcus aureus
UR - http://www.scopus.com/inward/record.url?scp=85151428130&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.clnu.2023.03.010
DO - https://doi.org/10.1016/j.clnu.2023.03.010
M3 - Article
C2 - 36965196
SN - 0261-5614
VL - 42
SP - 706
EP - 716
JO - Clinical nutrition (Edinburgh, Scotland)
JF - Clinical nutrition (Edinburgh, Scotland)
IS - 5
ER -