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Prevention Strategies for Recurrent Community-Associated Staphylococcus aureus Skin and Soft Tissue Infections

  • Skin, Soft Tissue, Bone and Joint Infectious Disease (N Safdar and A Pop-Vicas, Section Editors)
  • Published:
Current Infectious Disease Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Staphylococcus aureus skin and soft tissue infections (SSTI) are a major source of morbidity. More than half of patients experiencing SSTI will have at least one recurrent infection. These infections frequently cluster in households. Given the burden these infections pose to patients and healthcare, prevention strategies are of major clinical importance and represent an active area of research. Bacterial colonization is frequently an early and critical step in the pathogenesis of infection. As such, strategies to prevent reinfection have aimed to decrease staphylococcal colonization of the skin and mucus membranes, a process referred to as decolonization.

Recent Findings

Treatment of acute SSTI with incision and drainage and systemic antibiotics is the mainstay of therapy for healing of the acute infection. Systemic antibiotics also provide benefit through reduced incidence of recurrent SSTI. Education for patients and families regarding optimization of personal and household hygiene measures, and avoidance of sharing personal hygiene items, is an essential component in prevention efforts. For patients experiencing recurrent SSTI, or in households in which multiple members have experienced SSTI, decolonization should be recommended for all household members. A recommended decolonization regimen includes application of intranasal mupirocin and antiseptic body washes with chlorhexidine or dilute bleach water baths. For patients who continue to experience recurrent SSTI, periodic decolonization should be considered.

Summary

Personal decolonization with topical antimicrobials and antiseptics reduces the incidence of recurrent S. aureus SSTI. Future avenues for investigation include strategies for household environmental decontamination as well as manipulation of the host microbiota.

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Funding

J. Chase McNeil reports grants from Allergan, Merck, and Texas Children’s Hospital Pediatric Pilot Research Fund. Stephanie A. Fritz reports grants from the Children's Discovery Institute of Washington University and St, Louis Children's Hospital; National Institutes of Health (NIH)/National Institute of Allergy and Infectious Diseases [grant number K23-AI091690]; NIH/National Center for Advancing Translational Sciences [grant number UL1-TR002345]; and the Agency for Healthcare Research and Quality (AHRQ) [grant numbers R01-HS021736, R01-HS024269]

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  1. Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX, USA

    J. Chase McNeil

  2. Department of Pediatrics, Division of Infectious Diseases, Washington University School of Medicine, 660 S. Euclid Avenue, CB 8116, St. Louis, MO, 63110, USA

    Stephanie A. Fritz

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This article is part of the Topical Collection on Skin, Soft Tissue, Bone and Joint Infectious Disease

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McNeil, J.C., Fritz, S.A. Prevention Strategies for Recurrent Community-Associated Staphylococcus aureus Skin and Soft Tissue Infections. Curr Infect Dis Rep 21, 12 (2019). https://doi.org/10.1007/s11908-019-0670-0

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