Erschienen in:
01.06.2014 | Clinical and Epidemiological Study
Mupirocin/chlorexidine to prevent methicillin-resistant Staphylococcus aureus infections: post hoc analysis of a placebo-controlled, randomized trial using mupirocin/chlorhexidine and polymyxin/tobramycin for the prevention of acquired infections in intubated patients
verfasst von:
C. Camus, V. Sebille, A. Legras, B. Garo, A. Renault, P. Le Corre, P.-Y. Donnio, A. Gacouin, D. Perrotin, Y. Le Tulzo, E. Bellissant
Erschienen in:
Infection
|
Ausgabe 3/2014
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Abstract
Purpose
The reduction in acquired infections (AI) due to methicillin-resistant Staphylococcus aureus (MRSA) with the mupirocin/chlorhexidine (M/C) decontamination regimen has not been well studied in intubated patients. We performed post hoc analysis of a prior trial to assess the impact of M/C on MRSA AI and colonization.
Methods
We conducted a multicenter, placebo-controlled, randomized, double-blind study with the primary aim to reduce all-cause AI. The two regimens used [topical polymyxin and tobramycin (P/T), nasal mupirocin with chlorhexidine body wash (M/C), or corresponding placebos for each regimen] were administered according to a 2 × 2 factorial design. Participants were intubated patients in the intensive care units of three French university hospitals. The patients enrolled in the study (n = 515) received either active P/T (n = 130), active M/C (n = 130), both active regimens (n = 129), or placebos only (n = 126) for the period of intubation and an additional 24 h. The incidence and incidence rates (per 1,000 study days) of MRSA AI were assessed. Due to the absence of a statistically significant interaction between the two regimens, analysis was performed at the margins by comparing all patient receiving M/C (n = 259) to all patients not receiving M/C (n = 256), and all patients receiving P/T (n = 259) to all patients not receiving P/T (n = 256).
Results
Incidence [odds ratio (OR) 0.39, 95 % confidence interval (CI) (0.16–0.96), P = 0.04] and incidence rates [incidence rate ratio (IRR) 0.41, 95 % CI 0.17–0.97, P = 0.05] of MRSA AI were significantly lower with the use of M/C. We also observed an increase in the incidence (OR 2.50, 95 % CI 1.01–6.15, P = 0.05) and the incidence rate (IRR 2.90, 95 % CI 1.20–8.03, P = 0.03) of MRSA AI with the use of P/T.
Conclusion
Among our study cohort of intubated patients, the use of M/C significantly reduced MRSA AI.