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Are decontamination measures effective in preventing recurrent staphylococcal skin infection in children?
  1. Laure F Pittet1,2,
  2. Nigel Curtis1,2,3
  1. 1 Infectious Diseases Unit, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
  2. 2 Infectious Diseases Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
  3. 3 Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
  1. Correspondence to Professor Nigel Curtis, Department of Paediatrics, The University of Melbourne, The Royal Children Hospital, Parkville, VIC 3052, Australia; nigel.curtis{at}rch.org.au

https://doi.org/10.1136/archdischild-2019-318735

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    Scenario

    A healthy 8-year-old boy presents with recurrent staphylococcal skin infections, frequently requiring surgical drainage. Decolonisation of the patient and whole family with nasal mupirocin and chlorhexidine washes has been suggested. His parents ask how effective this or other interventions are likely to be (or not to be).

    Structured clinical question

    In an otherwise healthy child with recurrent community-acquired staphylococcal skin and soft tissue infections (SSTI) (patient), are decolonisation measures (intervention) over and above standard hygiene measures (comparator) effective in preventing recurrences (outcome)?

    Search

    Medline, Pubmed and EMBASE were searched in August 2019 with no language restriction. The search strategy is detailed in the online supplementary material.

    Supplemental material

    [archdischild-2019-318735supp001.pdf]

    Of 931 unique articles, after exclusion of studies on preoperative decolonisation, prevention of healthcare-associated infections or those involving exclusively adults, six articles addressed decolonisation of children with SSTI that potentially included recurrent cases (table 1). The references of all relevant publications were reviewed and no further articles were identified.

    Summary

    Four randomised control trials (RCTs)1–4 and two retrospective studies5 6 investigated the effectiveness of decolonisation measures on prevention of SSTI recurrence. None of the six studies was restricted to children with recurrent SSTI. In the three studies that reported the proportion of cases with recurrent SSTI, this figure was between 21% and 48%.2 3 6 In two studies, the proportion was not specified and in one, those with more than three previous SSTI were excluded. The proportion of cases with methicillin-resistant Staphylococcus aureus (MRSA) in the six studies was between 67% and 100%.

    The RCTs compared several decolonisation strategies applied to the index case alone,1 2 or to all household members.3 4 The interventions included a 5-day to 7-day course of intranasal mupirocin two times per day, combined or not with chlorhexidine body washes or bleach baths, both prescribed once a day or …

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    Footnotes

    • Twitter @pittetlaure, @nigeltwitt

    • Contributors LFP drafted the initial manuscript. NC critically revised the manuscript and both authors approved the final version as submitted.

    • Funding Dr Laure Pittet is supported by the Swiss National Science Foundation (Early Postdoc. Mobility grant number P2GEP3_178155).

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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