Topical Decolonization Does Not Eradicate the Skin Microbiota of Community-Dwelling or Hospitalized Adults
Topical antimicrobials are often employed for decolonization and infection prevention and may alter the endogenous microbiota of the skin. The objective of this study was to compare the microbial community, richness, and diversity in community-dwelling subjects and intensive care unit (ICU) patients before and after the use of topical decolonization protocols. We enrolled 15 adults at risk forStaphylococcus aureusinfection. Community subjects (n=8) underwent a 5-day decolonization protocol (twice daily intranasal mupirocin and daily dilute bleach water baths) and ICU patients (n=7) received daily chlorhexidine baths. Swab samples were collected from 5 anatomic sites immediately before, and again after, decolonization. A variety of culture media and incubation environments were used to recover bacteria and fungi; isolates were identified using matrix-assisted laser desorption ionization-time of flight mass spectrometry. Overall, 174 unique organisms were recovered. Unique communities of organisms were recovered from the community-dwelling and hospitalized cohorts. In the community-dwelling cohort, microbial richness and diversity did not differ significantly between collections across time points, although the number of body sites colonized withS. aureussignificantly decreased over time (P=0.004). Within the hospitalized cohort, richness and diversity decreased over time compared to the enrollment sampling (from enrollment to final sampling,P=0.01 for both richness and diversity). Topical antimicrobials reduced the burden ofS. aureuswhile preserving other components of the skin and nasal microbiota.