Value of whole-body washing with chlorhexidine for the eradication of methicillin-resistant Staphylococcus aureus:: A randomized, placebo-controlled, double-blind clinical trial

BACKGROUND. Whole-body washing with antiseptic solution has been widely used as part of eradication treatment for colonization with methicillin-resistant Staphylococcus aureus (MRSA), but evidence for the effectiveness of this measure is limited. OBJECTIVE. To study the efficacy of whole-body washing with chlorhexidine for the control of MRSA. DESIGN. Randomized, placebo-controlled, double-blinded clinical trial. SETTING. University Hospital of Heidelberg and surrounding nursing homes. PATIENTS. MRSA carriers who were not treated concurrently with antibiotics effective against MRSA were eligible for the study. INTERVENTION. Five days of whole-body washing with either 4% chlorhexidine solution (treatment group) or with a placebo solution. All patients received mupirocin nasal ointment and chlorhexidine mouth rinse. The outcome was evaluated 3, 4, 5, 9, and 30 days after treatment with swab samples taken from several body sites. RESULTS. Of 114 patients enrolled in the study (56 in the treatment group and 58 in the placebo group), 11 did not finish treatment (8 from the treatment group and 3 from the placebo group [P=.02]). At baseline, the groups did not differ with regard to age, sex, underlying condition, site of MRSA colonization, or history of MRSA eradication treatment. Eleven patients were MRSA-free 30 days after treatment (4 from the treatment group and 7 from the placebo group [P=.47]). Only groin-area colonization was significantly better eradicated by the use of chlorhexidine. The best predictor for total eradication was a low number of body sites positive for MRSA. Adverse effects were significantly more frequent in the treatment group than in the placebo group (any symptom, 71% vs 33%) but were reversible in most cases. CONCLUSION. Whole-body washing can reduce skin colonization, but it appears necessary to extend eradication measures to the gastrointestinal tract, wounds, and/or other colonized body sites if complete eradication is the goal.