E.W. "Al" Thrasher
Status: Funded - Open
Decolonization of the oropharynx, an important and neglected reservoir of S. aureus colonization
Loren Miller, M.D., MPH
BACKGROUND: Each year, four in 100 children will experience a medically attended skin infection, which are typically caused by Staphylococcus aureus, and result in over 2 million visits to doctors’ offices and emergency departments annually among children in the U.S. Over one third of children who experience a skin infection will have a recurrence in the following six months.
GAP: Prevention of skin infections commonly involve body decolonization of S. aureus with skin disinfectants such as chlorhexidine or diluted bleach, but the effectiveness of these agents have been very disappointing. Recent studies have shown that S. aureus commonly colonizes the oropharynx (throat) of children at a prevalence often higher than that of nasal colonization.
HYPOTHESIS: We hypothesize that suboptimal S. aureus prevention efforts stem from previous inattention to eradication of S. aureus oropharyngeal colonization. We hypothesize that, compared to placebo, 0.12% chlorhexidine rinse will reduce oral S. aureus colonization.
METHODS: We will perform a prospective, double blind, randomized controlled clinical trial of 0.12% chlorhexidine oral rinse versus placebo oral rinse for children age 5-17 with S. aureus oropharyngeal colonization. Our primary outcome is S. aureus eradication at 7 days. Secondary outcomes are eradication at 1 month (long term follow up), safety and tolerability of chlorhexidine, and S. aureus pathogen level factors, which we will quantify using whole genome sequencing of patient isolates.
IMPACT: Data from this study will form the foundation of more comprehensive efforts to prevent recurrent S. aureus infections in children.
Antibiotics, Staphylococcus, Human, Randomized Clinical Trial