Gompelman, M;
Wezendonk, GTJ;
Wouters, Y;
Beurskens-Meijerink, J;
Fragkos, KC;
Rahman, FZ;
Coolen, JPM;
... Wanten, GJA; + view all
(2023)
Randomized clinical trial: Long-term Staphylococcus aureus decolonization in patients on home parenteral nutrition.
Clinical Nutrition
, 42
(5)
pp. 706-716.
10.1016/j.clnu.2023.03.010.
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Abstract
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).
| Type: | Article |
|---|---|
| Title: | Randomized clinical trial: Long-term Staphylococcus aureus decolonization in patients on home parenteral nutrition |
| Location: | England |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1016/j.clnu.2023.03.010 |
| Publisher version: | https://doi.org/10.1016/j.clnu.2023.03.010 |
| Language: | English |
| Additional information: | © 2023 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). |
| Keywords: | Central venous access device, Central venous catheter, Decolonization, Home parenteral nutrition, S. aureus carriage, Staphylococcus aureus, Adult, Humans, Staphylococcus aureus, Anti-Bacterial Agents, Staphylococcal Infections, Risk Factors, Parenteral Nutrition, Home |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Eastman Dental Institute |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10173413 |
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