Researchers have found in a new study that reducing the incidence of skin and soft tissue infections (SSTIs) among individuals with prior SSTIs requires addressing both human and environmental reservoirs, emphasizing the close and interconnected role of these reservoirs in ongoing transmission and recurrence. The study, published in the Clinical Infectious Diseases journal by Alaina L. R. and colleagues, found that SSTIs due to Staphylococcus aureus are an important factor in the recurrence and maintenance of S. aureus infections among children and their families through persistent colonization and transmission of S. aureus among family members.
This study was an open-label randomized trial among families of children presenting with community-associated S. aureus SSTI, where families completed baseline decolonization and were then randomly assigned to implement either one of three interventions conducted over 3 months, consisting of a periodic and personal decolonization intervention, an environmental and hygiene intervention, or an integrated intervention combining both interventions.
During the period between 2015 and 2021, a total of 196 index pediatric patients and 623 household contacts were included in this clinical trial. All the index children presented with a prior history of community-associated S. aureus SSTI. There was a significant incidence of household members presenting with multiple SSTIs in the year before the study.
Key findings
At 3 months, no difference in cumulative household SSTI incidence was identified by the intervention arm.
Among participants with SSTI in the prior year, the integrated approach lowered SSTI incidence at 6 and 9 months.
In the previous year, SSTI remained the most robust predictor of future SSTI in multivariable analyses, while intervention assignment was not significant.
All interventions lowered MRSA colonization over 9 months, but MSSA colonization did not.
This clinical trial demonstrated that a combined personal and environmental decolonization model does not decrease household incidence of SSTI but might decrease SSTI recurrences within a household. Prior infection history is the best predictor of subsequent SSTIs. This suggests that existing decolonization and infection prevention measures have not been effective enough.
Reference:
Alaina L Robinson, Mary G Boyle, Patrick G Hogan, Sara M Malone, Melissa J Krauss, Lisa M Richardson, Melanie L Sullivan, Tyler Walsh, Rinat Tal, Lauren Walsh, Ryley M Thompson, Katelyn L Parrish, Carol E Muenks, Carey-Ann D Burnham, Stephanie A Fritz, Evaluating Personal and Environmental Decolonization Strategies for Children With Skin and Soft Tissue Infection and Their Households — A Randomized Clinical Trial, Clinical Infectious Diseases, 2025;, ciaf627, https://doi.org/10.1093/cid/ciaf627
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