TOPLINE:

A combined approach of personal decolonization and environmental hygiene yielded a sustained reduction in recurrent Staphylococcus aureus-related skin and soft tissue infections (SSTIs) among individuals with prior SSTIs.

METHODOLOGY:

• Researchers conducted a randomized trial of 835 participants (median age, 15 years; 56% girls) involving 196 pediatric patients with culture-confirmed, community-associated S aureus-related SSTIs and their 623 household contacts between 2015 and 2021 to assess several decolonization strategies.
• Participants were randomly assigned to one of three groups:
  • Periodic-personal group (n = 274), which received twice-weekly chlorhexidine bathing plus monthly intranasal mupirocin
  • Environmental-hygiene group (n = 269), which received weekly household surface disinfection along with enhanced laundry measures
  • Integrated-approach group (n = 292), which received both interventions (All interventions continued for 3 months.)
• The primary outcome was the cumulative SSTI incidence at the household level 3 months after randomization, comparing the integrated-approach group with a combined group of the periodic-personal approach and the environmental-hygiene approach.
• The secondary outcome involved comparing the integrated-approach group and the combined group at the household level at 1, 6, and 9 months.

TAKEAWAY:

• Among 180 evaluable households at 3 months, cumulative SSTI incidence did not significantly differ between the intervention groups (periodic personal group, 35%; environmental-hygiene group, 37%; integrated-approach group, 35%).
• Among participants with an SSTI in the prior year, those in the integrated-approach group vs combined group had lower SSTI incidence at 6 months (22% vs 34%) and 9 months (28% vs 40%; P = .04 for both).
• Cumulative SSTI incidence was associated with a prior SSTI in the year before enrollment, public rather than private health insurance, and higher methicillin-resistant S aureus contamination at the previous sampling.

IN PRACTICE:

“[Our study] determined that both human and environmental reservoirs must be addressed to impact SSTI incidence among participants with prior SSTI, emphasizing the close relationship between these reservoirs,” the authors wrote.

SOURCE:

This study was led by Alaina L. Robinson, PhD, Washington University School of Medicine, St Louis, Missouri. It was published online on November 24, 2025, in Clinical Infectious Diseases.

LIMITATIONS:

The study relied on participant self-reports of SSTIs, and recurrent isolates were unavailable for strain typing, preventing the determination of whether infections were caused by the original strain or newly acquired strains.

DISCLOSURES:

This study was supported by the Children’s Discovery Institute of Washington University and St Louis Children’s Hospital, the National Institutes of Health/National Institute of Allergy and Infectious Diseases, the National Center for Advancing Translational Sciences at the National Institutes of Health, and the Agency for Healthcare Research and Quality. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.