Having non-ICU patients bathe with chlorhexidine and use nasal mupirocin if they were known to carry methicillin-resistant Staphylococcus aureus (MRSA) did not reduce multidrug-resistant organisms, a study found.
The cluster-randomized trial included 53 hospitals, which measured 194 of their medical or surgical units' MRSA or vancomycin-resistant enterococcus (VRE) cultures during a baseline period from March 1, 2013, to Feb 28, 2014, a phase-in period from April 1, 2014, to May 31, 2014, and an intervention period from June 1, 2014, to Feb 29, 2016. During the intervention, the hospitals were randomized to either usual care or daily chlorhexidine bathing for all patients plus mupirocin for known MRSA carriers.
There were 189,081 patients in the baseline period and 339,902 patients in the intervention period (156,889 receiving routine care and 183,013 undergoing decolonization). On the primary outcome of unit-attributable MRSA-positive or VRE-positive clinical cultures, the control and intervention groups both saw decreases between the baseline and intervention periods and the difference between groups was not significant (hazard ratios for intervention period vs. baseline, 0.79 [95% CI, 0.73 to 0.87] with decolonization vs. 0.87 [95% CI, 0.79 to 0.95] with routine care. There were 25 adverse events, all involving chlorhexidine. Results were published by The Lancet on March 5.
“These results were neither significant nor clinically meaningful for a broad-based intervention strategy,” the study authors said. A post hoc analysis did find significant benefits to the intervention among a high-risk subgroup of patients with medical devices, they noted. Similar decolonization strategies have been successful at reducing infection rates in ICUs and might be more effective in a population with a higher prevalence or risk of multidrug-resistant infection, the authors said.
Another recent study found that declines in hospital-onset MRSA infections in the U.S. have slowed in recent years. According to a report in the March 5 Morbidity and Mortality Weekly Report, hospital-onset MRSA bloodstream infections decreased by 17.1% annually in 2005 through 2012, but the decline slowed during 2013 through 2016. “To reduce the incidence of these infections further, health care facilities should take steps to fully implement CDC recommendations for prevention of device- and procedure-associated infections and for interruption of transmission,” the authors said.
Another article in the same issue reported that at Veterans Affairs Medical Centers, hospital-onset MRSA decreased by 66% from 2005 through 2017, with infections declining more among patients who had negative admission surveillance MRSA screening tests (annual 9.7% decline) than those with positive admission MRSA screening tests (4.2%).