Cultures Before and After Decolonization in Community Dwelling Adults With Current S. Aureus Colonization

Phase 4

Completed

Interventions: Drug: Mupirocin calcium ointment, 2%
Drug: Topical Chlorhexidine, 4%

Brief Summary: The investigators propose to study the microbiome of the nose, throat and three skin sites in a population without current exposure to the healthcare environment: 80 community dwelling adults. We will characterize the microbial communities in these body sites (nose, throat, perirectal and three skin sites) over time using culture-independent techniques. The investigators will then "decolonize" the subjects. Subjects will receive intranasal mupirocin and topical chlorhexidine. The investigators will then compare the microbial communities at baseline and after decolonization within individuals. Our overall hypothesis is that the microbial composition of these sites and the response to decolonization is influenced by the healthcare environment and that decolonization leads to re-colonization with an increasing proportion of Gram-negative bacilli.

Recruitment & Eligibility

Inclusion Criteria

Veteran living in the greater Baltimore, MD area
Adults >= 18 years of age
Living independently
Willing and able to provide anterior nares, skin, throat, and perirectal specimens over an 18 week time period.
Willing and able to administer intranasal mupirocin and topical chlorhexidine over a five day period
Capable of understanding and complying with the entire study protocol.
Provided signed and dated informed consent

Exclusion Criteria

Use of anticancer chemotherapy or radiation therapy (cytotoxic) within the past 6 months
History of HIV infection with most recent CD4 of <200
Immunosuppression medications within the past 3 months
Use of systemic antibacterial or antifungal agents in the past 3 months
Use of nasal steroids currently or in the past 3 months
Use of nasal antimicrobial ointment in the past 3 months
Any current indwelling percutaneous medical device or urinary catheter
Acute care hospitalization in the past 3 months
Planned surgery or hospitalization during the study period
History of an allergic reaction to chlorhexidine or mupirocin
Oral temperature of >100 F at enrollment visit
BMI <18 or >35 at enrollment visit

Arm && Interventions

Group	Intervention	Description
Intranasal Mupirocin and Topical Chlorhexidine	Mupirocin calcium ointment, 2%	Antimicrobial antiseptic skin cleanser (4% chlorhexidine) for daily use on Day 1, 3 and 5 of Week 8 of the study. BACTROBAN NASAL ointment (mupirocin calcium ointment, 2%) for use intranasally twice-daily on Day 1, 2, 3, 4 and 5 of Week 8 of the study.
Intranasal Mupirocin and Topical Chlorhexidine	Topical Chlorhexidine, 4%	Antimicrobial antiseptic skin cleanser (4% chlorhexidine) for daily use on Day 1, 3 and 5 of Week 8 of the study. BACTROBAN NASAL ointment (mupirocin calcium ointment, 2%) for use intranasally twice-daily on Day 1, 2, 3, 4 and 5 of Week 8 of the study.

Primary Outcome Measures

Name	Time	Method
Change in the Abundance of Staphylococcus Aureus in the Nose After Decolonization	8 weeks	Change in the abundance of Staphylococcus aureus in the nose from immediately before mupirocin administration to 8 weeks after mupirocin administration.
Change in the Abundance of Staphylococcus Aureus in the Throat After Decolonization	8 weeks	Change in the abundance of Staphylococcus aureus in the throat from immediately before mupirocin administration to 8 weeks after mupirocin administration.
Change in the Abundance of Gram Negative Bacteria on the Subclavian Skin After Decolonization	12 months	Quantitative PCR using 16S rRNA is used to quantify the total bacterial load of Gram negative bacteria on the subclavian skin before and after decolonization.
Change in the Abundance of Gram Negative Bacteria on the Femoral Skin After Decolonization	12 months	Quantitative PCR using 16S rRNA is used to quantify the total bacterial load of Gram negative bacteria on the femoral skin before and after decolonization.