Staphylococcus aureus decolonization for recurrent skin and soft tissue infections in children.

QUESTION: I see otherwise healthy children in my practice with recurrent staphylococcal skin infections. While I am comfortable with managing each acute infection, what can be done to eradicate Staphylococcus aureus and reduce the chance of recurrent infections? ANSWER: Staphylococcus aureus skin and soft tissue infections (SSTIs) are common in children and are increasing in frequency. Risk factors for the development of staphylococcal SSTIs are colonization with S aureus and recent diagnosis of SSTI in a household member. Current evidence suggests that a combined strategy using hygiene education, nasal mupirocin, and bath washes with chlorhexidine or diluted bleach has the most success in decolonization. However, decolonization appears to only provide temporary reduction in carriage rate. According to the limited research in the ambulatory population, decolonization of a patient does not confer a reduced risk of recurrent infections. Further research and large studies are required to understand the factors in S aureus pathogenesis and whether decolonization of a child and his or her household is of benefit in reducing subsequent S aureus infections.