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Universal decolonization decreases candiduria, bacteriuria in ICU
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Universal decolonization of ICU patients, through once-daily chlorhexidine baths and short-course nasal mupirocin, significantly decreased candiduria and any bacteriuria, and could be a possible infection prevention strategy in males, but not in females, according to study results in The Lancet Infectious Diseases.
“Urinary tract infections (UTIs) are one of the most common hospital-associated infections with 93,000 annual cases reported in the [U.S.], incurring an excess cost of $900 per episode,” Susan S. Huang, MD, professor of infectious disease at the University of California Irvine School of Medicine, and colleagues wrote. “Thirty-eight percent of these occur in the ICU where urinary catheters are commonly used.”
Susan S. Huang
To assess the effect of decolonization on candiduria and bacteriuria in ICU patients, the researchers conducted a secondary analysis of the REDUCE MRSA trial, a large, cluster-randomized study of 43 hospitals and 122,646 adult patients in the U.S. The patients were assigned to three groups — MRSA screening and isolation, targeted decolonization with chlorhexidine and mupirocin, or universal decolonization with chlorhexidine and mupirocin. Due to the higher risk for infection in women from endogenous flora, the researchers specified, a priori, analyses stratified by sex. Proportional hazard models were used to assess the differences between groups.
According to the researchers, the intervention vs. baseline HR for high-level bacteriuria showed no differences between the groups. HR for high-level candiduria showed significant differences between groups and among men, but not women. The researchers said the differences between sexes were due to infection reductions in men in the universal decolonization group. Low-level bacteriuria HR also indicated reduced infection among men in the universal decolonization group.
In all, the researchers found universal decolonization prevented 37% of high-level candiduria, and 26% of bacteriuria events, in male ICU patients.
“Further studies will be needed to determine if these reductions translate to other clinical correlates of UTI,” Huang and colleagues wrote. “Nevertheless, this reduction is likely to be generally achievable in most hospitals given the pragmatic nature of this study being completed in mostly community hospitals.
“These data add to the growing benefits of universal decolonization in preventing health care-associated infections in the ICU setting.” – by Jason Laday
Disclosure: Huang reports completing a clinical trial in which participating hospitals receive products from Sage Products and Molnlycke. Please see the full study for a list of all other authors’ relevant financial disclosures.
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