Randomized clinical trial: Long-term Staphylococcus aureus decolonization in patients on home parenteral nutrition

• DOI: 10.1016/j.clnu.2023.03.010
• Publication Date: 2023-03-17T16:11:07Z
• Authors: Michelle Gompelman; Guus T.J. Wezendonk; Yannick Wouters; Judith Beurskens-...; Konstantinos C. F...; Farooq Z. Rahman; Jordy P.M. Coolen; Ingrid J.M. van W...; Heiman F.L. Wertheim; Wietske Kievit; Reinier P. Akkermans; Mireille J. Serlie; Chantal P. Bleeke...; Geert J.A. Wanten
• Keywords: Radboudumc 18: Healthcare improvement science IQ Healthcare; Adult; Home parenteral nutrition; Parenteral Nutrition; Radboudumc 4: lnfectious Diseases and Global Health Internal Medicine; Staphylococcus aureus; Radboud University Medical Center; Radboudumc 18: Healthcare improvement science Primary and Community Care; S. aureus carriage; Radboudumc 18: Healthcare improvement science 18-Primary and Community Care; Staphylococcal Infections; Radboudumc 4: lnfectious Diseases and Global Health Medical Microbiology; 3. Good health; Radboudumc 4: lnfectious Diseases and Global Health Gastroenterology; Anti-Bacterial Agents; Decolonization; Central venous access device; Risk Factors; Radboudumc 18: Healthcare improvement science Health Evidence; Humans; Home; Parenteral Nutrition, Home; Central venous catheter

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.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.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.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).