10 Oct Emory/CDC Study Finds Combination Strategy Reduces Hospital Acquired Staph Infections
MedicalResearch.com Interview with:
Dr. Jernigan
Dr. John Jernigan, MD MS
Clinical Associate Professor of Medicine
Division of Infectious Diseases
Emory University School of Medicine
Branch Chief
Epidemiology, Research and Innovations Branch
CDC Center for Disease Control
MedicalResearch.com: What is the background for this study?
Response: Staphylococcus aureus commonly causes infections in ICUs. One approach to preventing these infections is using nasal mupirocin plus chlorhexidine gluconate (CHG) bathing for ICU patients. This practice is known to prevent methicillin-resistant Staphylococcus aureus (MRSA) infections and all-cause. bloodstream infections. This practice has been broadly adopted in ICUs in the US, but adoption of mupirocin as a universal topical antibiotic has been slowed by concerns for engendering mupirocin resistance.
This cluster-randomized trial in adult ICUs was conducted to assess whether universal nasal antiseptic povidone-iodine (iodophor), to which minimal S. aureus resistance is expected, was an acceptable alternative to universal nasal mupirocin for reducing S. aureus and MRSA clinical cultures in the setting of daily CHG bathing. Those who received chlorhexidine (CHG) bathing with mupirocin had an 18% reduction in risk of Staphylococcus aureus clinical cultures and a 15% reduction in risk of methicillin-resistant S. aureus (MRSA) clinical cultures compared to patients who received CHG bathing with intranasal iodophor. These results show that using mupirocin for nasal decolonization may be preferred over iodophor because it is more effective at preventing S. aureus infections.
MedicalResearch.com: What are the barriers to implementation of this protocol? Is there a potential for mupirocin-resistant organisms to develop? Allergic reactions?
Response: One potential barrier to implementation of this practice has been concern that widespread use of mupirocin could lead to increases in mupirocin resistance. However, the findings in this study were compared to those of a trial in the same health system conducted seven years earlier, and the comparison found that there was no reduction in the benefit of mupirocin-CHG. The lack of decrement in clinical benefit over 7 years of continuous use in a large health system provides reassurance that the mupirocin-CHG regimen may not engender clinically meaningful resistance. The safety and tolerability of this regimen was well documented not only in this trial, but also in the trial that was conducted seven years earlier.
One additional point:
This study provides further evidence that pathogen burden reduction is a highly impactful strategy for preventing HAIs. To maximize the impact of this strategy, we need more agents to be developed and brought to market to extend the benefit of pathogen reduction. In 2022, CDC and FDA hosted a workshop describing the need for supporting decolonization strategies to reduce the risk of HAIs. This study and related studies are critical for building the evidence base to support future decolonization strategies.
Nothing to disclose.
Citation:
Huang SS, Septimus EJ, Kleinman K, et al. Nasal Iodophor Antiseptic vs Nasal Mupirocin Antibiotic in the Setting of Chlorhexidine Bathing to Prevent Infections in Adult ICUs: A Randomized Clinical Trial. JAMA. 2023;330(14):1337–1347. doi:10.1001/jama.2023.17219
https://jamanetwork.com/journals/jama/fullarticle/2810510?resultClick=1
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