Chlorhexidine Does Not Reduce MDR Organisms in Non-ICU Hospital Areas

By Will Boggs MD

April 04, 2019

NEW YORK (Reuters Health) - Chlorhexidine bathing is no better than routine bathing for preventing multidrug-resistant organisms and all-cause bloodstream infections in non-critical-care hospital patients, according to results from the ABATE Infection trial.

"This was a large-scale trial in community hospitals in the HCA Healthcare system," Dr. Susan S. Huang of the University of California, Irvine, School of Medicine told Reuters Health by email. "It used a pragmatic approach where the intervention was rolled out by local quality improvement hospital leaders."

The findings were published in The Lancet, online March 5.

Dr. Huang and colleagues from 53 hospitals evaluated whether the use of a chlorhexidine bathing intervention previously found to reduce multidrug-resistant organisms and bacteremia in intensive-care units (ICUs) was similarly effective in non-ICU patients, compared with routine bathing. The chlorhexidine group also received targeted decolonization with mupirocin ointment for known MRSA carriers.

The primary outcome, reduction in combined methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enterococcus (VRE) clinical cultures attributable to a participating unit, did not differ significantly between the chlorhexidine group (21% reduction) and the routine care group (13% reduction).

There was also no significant difference between the chlorhexidine and routine care groups in multidrug-resistant Gram-negative rod clinical cultures (9% vs. 19% reduction, respectively) or in all-pathogen bloodstream infections (10% vs. 4% reduction).

In post-hoc analyses, however, patients with medical devices had a 32% greater reduction in all-cause bacteremia and a 37% greater reduction in MRSA or VRE clinical cultures with chlorhexidine bathing than with routine bathing.

"The fact that the 10% of patients with devices were responsible for over half of all bloodstream infection outside of the ICU and more than one-third of MRSA and VRE outside of the ICU suggests that this would be a high-value subpopulation to be targeted for decolonization," Dr. Huang said.

There were 25 (<1% of patients) adverse events, all involving chlorhexidine. All events were associated with mild pruritus or rash, and all resolved rapidly upon discontinuation of chlorhexidine bathing.

"Physicians and hospital infection prevention programs should consider targeted chlorhexidine bathing for patients with devices outside of the ICU and added use of nasal mupirocin in MRSA carriers who have devices to reduce their risk of bloodstream infection and antibiotic-resistant organisms," Dr. Huang said.

"These results were found in spite of the apparent strong compliance with the decolonization process," write Dr. Olivier Mimoz and Dr. Jeremy Guenezan from Centre Hospitalier Universitaire de Poitiers, France, in a linked editorial. "In real-world situations, numerous factors have been put forward as explanations for weaker compliance with universal decolonization. These include patient refusal to bathe, skin intolerance to chlorhexidine, negative perceptions by nursing staff on the benefits of baths, and heavy staff workload."

"Implementation of decolonization in non-critical care units thus requires additional evidence before being recommended," they conclude.


Lancet 2019.


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