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Skin and Soft Tissue Infections

Each year, thousands of service members are afflicted with skin and soft-tissue infections (SSTI). Moreover, during the last decade, SSTI caused by methicillin-resistant Staphylococcus aureus (MRSA), have become endemic in military training settings. These infections result in significant morbidity and impair military missions both for deployed service members and trainees. Although we have made considerable progress, increased SSTI rates in the era of community-associated MRSA have exposed gaps in our understanding of the epidemiology, immunology, and optimal prevention and treatment of these infections. Attacking these gaps is critical for the development of evidence-based treatment strategies and informing effective prevention strategies.

Partners and Collaborators

IDCRP efforts in the field of SSTI have addressed numerous aspects of SSTI, especially MRSA SSTI, ranging from epidemiology to prevention studies. These research efforts have led to collaborations with Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH), the Global Emerging Infections Surveillance (GEIS), Nabi Biopharmaceuticals, Naval Medical Research Center (NMRC), USUHS (Microbiology), Fort Benning (Martin Army Community Hospital), and on submarines.

Key Studies

IDCRP-001: Chlorhexidine Impregnated Cloths to Prevent Skin and Soft Tissue Infections in Marine Officer Candidates: A Randomized, Double-Blind, Placebo-Controlled Trial

IDCRP-035:  Evaluate the safety and immunogenicity of Staphylococcus aureus toxoid (rAT and rLuKS-PVL)

IDCRP-055: Evaluating strategies to prevent methicillin-resistant Staphylococcus aureus skin and soft tissue infections in military trainees at Fort Benning, Georgia

IDCRP-066: The disease and cost burden of SSTIs and MRSA-associated SSTIs in the U.S. Army Active Duty Training Population

IDCRP-068: Evaluation of the Prevalence of Staphylococcus aureus Colonization and Risk Factors for Infection among Naval Personnel in a Deployment Setting: a pilot study

IDCRP-074: Skin and soft-tissue infection in military trainees: epidemiology and economic burden of disease

IDCRP-090: Natural history of Staphylococcus aureus colonization, infection, and immune response in military trainees

Military Impact

  1. IDCRP generated evidence to inform DoD recruit training SSTI prevention policy (TRADOC) – MCB Quantico and Fort Benning
  2. MRSA surveillance in support of DoD-GEIS mission
  3. Determine incidence and operational impact of SSTI in high-risk DoD operational settings (e.g., shipboard, submarines)
  4. Army accession SSTI/MRSA burden/cost of illness (information to be provided to the MIDRP Staph vaccine working group)

Publications 2014

Ellis MW, Schlett CD, Millar EV, et al. Prevalence of nasal colonization and strain concordance in patients with community-associated Staphylococcus aureus skin and soft-tissue infectionsInfection Control and Hospital Epidemiology. 2014; 35(10):1251-1256. 

Schlett CD, Millar EV, Crawford KB, et al. Prevalence of chlorhexidine-resistant methicillin-resistant Staphylococcus aureus following prolonged exposureAntimicrobial Agents and Chemotherapy. 2014; 58(8):4404-4410. 

Ellis MW, Schlett CD, Millar EV, et al. Hygiene strategies to prevent methicillin-resistant Staphylococcus aureus skin and soft-tissue infections: A cluster-randomized controlled trial among high-risk military traineesClinical Infectious Diseases. 2014; 51(11):1540-1548.

Ellis MW, Johnson R, Crawford KB, et al. Molecular characterization of a catalase-negative methicillin-susceptible Staphylococcus aureus subsp. aureus strain collected from a patient with cutaneous abscess. Journal of Clinical Microbiology. 2014; 52(1):344-346.

Johnson R, Ellis MW, Lanier JB, et al.  Correlation between nasal microbiome composition and remote purulent skin and soft tissue infectionsInfection and Immunity. 2015; 83(2):802-811.

D’Onofrio MJ, Schlett CD, Millar EV, et al. Reduction in acute gastroenteritis among military trainees: Secondary effects of a hygiene-based cluster-randomized trial for skin and soft tissue infection prevention. Infection Control and Hospital Epidemiology. In Press. doi: 10.1017/ice.2014.65.

Millar EV, Chen W, Schlett CD, et al.  Frequent use of chlorhexidine-based body wash associated with a reduction in methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization among military trainees. Clinical Infectious Diseases. In Press. doi: 10.1128/AAC.03993-14.

Heaton SM, Weintrob AC, Downing K, Keenan B, Aggarwal D, Shaikh F, Tribble DR, Wells J, and the IDCRP TIDOS Group. Histopathological Techniques for the Diagnosis of Combat-Related Invasive Fungal Wound Infections. BMC Clinical Pathology. 2016; 16:11.

Presentations 2014

Ellis MW, Schlett CD, Cui T, et al. Epidemiology of skin and soft-tissue infections in US Army trainees at Fort Benning. ID Week, A Joint Meeting of IDSA, SHEA, HIVMA, and PIDS, 8-12 October 2014, Philadelphia, PA.

Ellis MW, Chen W, Millar EV, et al. Routine use of chlorhexidine-based body wash associated with a reduction in methicillin-resistant Staphylococcus aureus nasal colonization among military trainees.  ID Week, A Joint Meeting of IDSA, SHEA, HIVMA, and PIDS, 8-12 October 2014, Philadelphia, PA.

D’Onofrio MJ, Schlett CD, Millar EV, et al. Reduction in acute gastrointestinal infection among military trainees: Secondary effects of a hygiene-based cluster-randomized trial for SSTI prevention.  ID Week, A Joint Meeting of IDSA, SHEA, HIVMA, and PIDS, 8-12 October 2014, Philadelphia, PA.

Ellis MW, Lanier JB, Schlett CD, et al. Combating Staphylococcal skin and soft-tissue infections in trainees at Fort Benning.  Military Health System Research Symposium, 18-21 August 2014, Fort Lauderdale, FL.

Ellis MW, Schlett CD, Millar EV, et al. Epidemiology of skin and soft-tissue infections in trainees at Fort Benning.  Military Health System Research Symposium, 18-21 August 2014, Fort Lauderdale, FL.

Johnson R, Lanier JB, Schlett CD, et al.  Impact of the nasal microbiome on the development of Staphylococcal skin and soft-tissue infections at Fort Benning.  114th General Meeting of the American Society for Microbiology, 17-20 May 2014, Boston, MA; and Military Health System Research Symposium, 18-21 August 2014, Fort Lauderdale, FL.