AI Article Synopsis

  • A study was conducted in US ICUs to assess the effectiveness of iodophor compared to mupirocin for nasal decolonization combined with chlorhexidine gluconate (CHG) bathing, targeting prevention of MRSA infections and bloodstream infections.
  • The trial included over 800,000 ICU patients, with results showing that iodophor-CHG had a slightly higher hazard ratio for S. aureus clinical isolates compared to mupirocin-CHG during the intervention period.
  • The overall aim was to explore the potential benefits of using an antiseptic like iodophor amid increasing concerns about mupirocin resistance, while ensuring the new method was at least as effective as the traditional mupirocin-CHG approach

Article Abstract

Importance: Universal nasal mupirocin plus chlorhexidine gluconate (CHG) bathing in intensive care units (ICUs) prevents methicillin-resistant Staphylococcus aureus (MRSA) infections and all-cause bloodstream infections. Antibiotic resistance to mupirocin has raised questions about whether an antiseptic could be advantageous for ICU decolonization.

Objective: To compare the effectiveness of iodophor vs mupirocin for universal ICU nasal decolonization in combination with CHG bathing.

Design, Setting, And Participants: Two-group noninferiority, pragmatic, cluster-randomized trial conducted in US community hospitals, all of which used mupirocin-CHG for universal decolonization in ICUs at baseline. Adult ICU patients in 137 randomized hospitals during baseline (May 1, 2015-April 30, 2017) and intervention (November 1, 2017-April 30, 2019) were included.

Intervention: Universal decolonization involving switching to iodophor-CHG (intervention) or continuing mupirocin-CHG (baseline).

Main Outcomes And Measures: ICU-attributable S aureus clinical cultures (primary outcome), MRSA clinical cultures, and all-cause bloodstream infections were evaluated using proportional hazard models to assess differences from baseline to intervention periods between the strategies. Results were also compared with a 2009-2011 trial of mupirocin-CHG vs no decolonization in the same hospital network. The prespecified noninferiority margin for the primary outcome was 10%.

Results: Among the 801 668 admissions in 233 ICUs, the participants' mean (SD) age was 63.4 (17.2) years, 46.3% were female, and the mean (SD) ICU length of stay was 4.8 (4.7) days. Hazard ratios (HRs) for S aureus clinical isolates in the intervention vs baseline periods were 1.17 for iodophor-CHG (raw rate: 5.0 vs 4.3/1000 ICU-attributable days) and 0.99 for mupirocin-CHG (raw rate: 4.1 vs 4.0/1000 ICU-attributable days) (HR difference in differences significantly lower by 18.4% [95% CI, 10.7%-26.6%] for mupirocin-CHG, P < .001). For MRSA clinical cultures, HRs were 1.13 for iodophor-CHG (raw rate: 2.3 vs 2.1/1000 ICU-attributable days) and 0.99 for mupirocin-CHG (raw rate: 2.0 vs 2.0/1000 ICU-attributable days) (HR difference in differences significantly lower by 14.1% [95% CI, 3.7%-25.5%] for mupirocin-CHG, P = .007). For all-pathogen bloodstream infections, HRs were 1.00 (2.7 vs 2.7/1000) for iodophor-CHG and 1.01 (2.6 vs 2.6/1000) for mupirocin-CHG (nonsignificant HR difference in differences, -0.9% [95% CI, -9.0% to 8.0%]; P = .84). Compared with the 2009-2011 trial, the 30-day relative reduction in hazards in the mupirocin-CHG group relative to no decolonization (2009-2011 trial) were as follows: S aureus clinical cultures (current trial: 48.1% [95% CI, 35.6%-60.1%]; 2009-2011 trial: 58.8% [95% CI, 47.5%-70.7%]) and bloodstream infection rates (current trial: 70.4% [95% CI, 62.9%-77.8%]; 2009-2011 trial: 60.1% [95% CI, 49.1%-70.7%]).

Conclusions And Relevance: Nasal iodophor antiseptic did not meet criteria to be considered noninferior to nasal mupirocin antibiotic for the outcome of S aureus clinical cultures in adult ICU patients in the context of daily CHG bathing. In addition, the results were consistent with nasal iodophor being inferior to nasal mupirocin.

Trial Registration: ClinicalTrials.gov Identifier: NCT03140423.

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10565599PMC
http://dx.doi.org/10.1001/jama.2023.17219DOI Listing

Publication Analysis

Top Keywords

nasal mupirocin
8
all-cause bloodstream
8
bloodstream infections
8
universal decolonization
8
aureus clinical
8
clinical cultures
8
primary outcome
8
raw rate
8
icu-attributable days
8
mupirocin-chg
5

Similar Publications

Background: The colonization of (SA) acquired in nosocomial infections may develop acute and chronic infections such as Methicillin-Resistant (MRSA) in the nose. As a commensal microorganism with the ability to form a biofilm, SA can dwell on the skin, nostrils, throat, perineum, and axillae of healthy humans. Nitric oxide (NO) is an unstable gas with various molecular functions and has antimicrobial properties which are converted into many potential treatments.

View Article and Find Full Text PDF

Background: Throat carriage of methicillin-resistant (MRSA) has previously been associated with lower decolonisation treatment success rates.

Objectives: To characterise decolonisation treatment and outcome in Danish MRSA throat carriers.

Methods: This retrospective population-based cohort study included MRSA throat carriers between July, 2018 and June, 2019, in the Capital Region of Denmark.

View Article and Find Full Text PDF

Effect of Staphylococcal Decolonization Regime on Post-Craniotomy Meningitis.

Acta Neurochir Suppl

November 2024

Department of Neurological Sciences, Christian Medical College, Vellore, India.

Post craniotomy meningitis (PCM), an uncommon complication following craniotomy can be categorized as either bacterial meningitis (BM) or aseptic meningitis (AM) based on the results of CSF culture. Staph. aureus is a common causative organism.

View Article and Find Full Text PDF

Decolonization of Staphylococcus aureus Prior to Cardiac Implantable Electronic Device Implantation: Evaluating Preoperative Yield.

Isr Med Assoc J

November 2024

Department of Cardiology, Samson Assuta Ashdod University Hospital, Ashdod, Israel, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.

Background: Cardiac implantable electronic devices (CIEDs) are associated with risks of device-related infections (DRI) impacting major adverse outcomes. Staphylococcus aureus (SA) is a leading cause of early pocket infection and bacteremia. While studies in other surgical contexts have suggested that nasal mupirocin treatment and chlorhexidine skin washing may reduce colonization and infection risk, limited data exist for CIED interventions.

View Article and Find Full Text PDF

Want AI Summaries of new PubMed Abstracts delivered to your In-box?

Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!

A PHP Error was encountered

Severity: Notice

Message: fwrite(): Write of 34 bytes failed with errno=28 No space left on device

Filename: drivers/Session_files_driver.php

Line Number: 272

Backtrace:

A PHP Error was encountered

Severity: Warning

Message: session_write_close(): Failed to write session data using user defined save handler. (session.save_path: /var/lib/php/sessions)

Filename: Unknown

Line Number: 0

Backtrace: