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

VA Office of Research and Development58 enrolled

Overview

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.

Study Type

INTERVENTIONAL

Allocation

Purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Enrollment

Conditions

Human Microbiome

Interventions

Eligibility

Sex: ALLMin age: 18 YearsHealthy volunteers:

Medical Language ↔ Plain English

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

Outcomes

Primary Outcomes

Change in the Abundance of Staphylococcus Aureus in the Nose After Decolonization

Change in the abundance of Staphylococcus aureus in the nose from immediately before mupirocin administration to 8 weeks after mupirocin administration.

Time frame: 8 weeks

Change in the Abundance of Staphylococcus Aureus in the Throat After Decolonization

Change in the abundance of Staphylococcus aureus in the throat from immediately before mupirocin administration to 8 weeks after mupirocin administration.

Time frame: 8 weeks

Change in the Abundance of Gram Negative Bacteria on the Subclavian Skin After Decolonization

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.

Time frame: 12 months

Change in the Abundance of Gram Negative Bacteria on the Femoral Skin After Decolonization

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.