Chlorhexidine versus routine bathing to prevent multidrug-resistant organisms and all-cause bloodstream infections in general medical and surgical units (ABATE Infection trial): a cluster-randomised trial
| Autor: | Tyler Forehand, Edward Septimus, Ken Kleinman, Mary K. Hayden, Lauren Shimelman, John A. Jernigan, Jonathan B. Perlin, Julia Moody, Abate Infection trial team, Richard Platt, Robert A. Weinstein, Lena M. Portillo, Jason Hickok, Lauren Heim, Katherine Haffenreffer, Caren Spencer-Smith, Susan S. Huang, Julie Lankiewicz, Michael V. Murphy, Taliser R. Avery, Micaela H Coady, Jalpa Sarup-Patel, Adrijana Gombosev, Rebecca E. Kaganov |
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| Rok vydání: | 2019 |
| Předmět: |
Male
Bathing Outcome Assessment Drug Resistance Bacteremia 030204 cardiovascular system & hematology Medical and Health Sciences law.invention chemistry.chemical_compound 0302 clinical medicine Randomized controlled trial Anti-Infective Agents law Drug Resistance Multiple Bacterial Outcome Assessment Health Care Infection control 030212 general & internal medicine education.field_of_study Chlorhexidine Bacterial General Medicine Staphylococcal Infections Middle Aged Intensive Care Units Infectious Diseases Mupirocin Local Intranasal Administration Carrier State Female Patient Safety Infection Multiple medicine.drug Methicillin-Resistant Staphylococcus aureus medicine.medical_specialty Staphylococcus aureus Clinical Trials and Supportive Activities Population 03 medical and health sciences Clinical Research Intensive care Internal medicine General & Internal Medicine medicine Humans education Administration Intranasal Aged Infection Control business.industry Prevention Baths ABATE Infection trial team Clinical trial Health Care Emerging Infectious Diseases chemistry Anti-Infective Agents Local Antimicrobial Resistance business |
| Zdroj: | Lancet (London, England), vol 393, iss 10177 |
| ISSN: | 0206-3867 |
| Popis: | BACKGROUND:Universal skin and nasal decolonisation reduces multidrug-resistant pathogens and bloodstream infections in intensive care units. The effect of universal decolonisation on pathogens and infections in non-critical-care units is unknown. The aim of the ABATE Infection trial was to evaluate the use of chlorhexidine bathing in non-critical-care units, with an intervention similar to one that was found to reduce multidrug-resistant organisms and bacteraemia in intensive care units. METHODS:The ABATE Infection (active bathing to eliminate infection) trial was a cluster-randomised trial of 53 hospitals comparing routine bathing to decolonisation with universal chlorhexidine and targeted nasal mupirocin in non-critical-care units. The trial was done in hospitals affiliated with HCA Healthcare and consisted of a 12-month baseline period from March 1, 2013, to Feb 28, 2014, a 2-month phase-in period from April 1, 2014, to May 31, 2014, and a 21-month intervention period from June 1, 2014, to Feb 29, 2016. Hospitals were randomised and their participating non-critical-care units assigned to either routine care or daily chlorhexidine bathing for all patients plus mupirocin for known methicillin-resistant Staphylococcus aureus (MRSA) carriers. The primary outcome was MRSA or vancomycin-resistant enterococcus clinical cultures attributed to participating units, measured in the unadjusted, intention-to-treat population as the HR for the intervention period versus the baseline period in the decolonisation group versus the HR in the routine care group. Proportional hazards models assessed differences in outcome reductions across groups, accounting for clustering within hospitals. This trial is registered with ClinicalTrials.gov, number NCT02063867. FINDINGS:There were 189 081 patients in the baseline period and 339 902 patients (156 889 patients in the routine care group and 183 013 patients in the decolonisation group) in the intervention period across 194 non-critical-care units in 53 hospitals. For the primary outcome of unit-attributable MRSA-positive or VRE-positive clinical cultures (figure 2), the HR for the intervention period versus the baseline period was 0·79 (0·73-0·87) in the decolonisation group versus 0·87 (95% CI 0·79-0·95) in the routine care group. No difference was seen in the relative HRs (p=0·17). There were 25 ( |
| Databáze: | OpenAIRE |
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