{"id":24835,"date":"2023-10-15T04:13:00","date_gmt":"2023-10-14T20:13:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=24835"},"modified":"2023-10-15T05:48:09","modified_gmt":"2023-10-14T21:48:09","slug":"jama%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e6%b4%97%e5%bf%85%e6%b3%b0%e6%b4%97%e6%b5%b4%e6%9d%a1%e4%bb%b6%e4%b8%8b%e9%bc%bb%e9%83%a8%e4%bd%bf%e7%94%a8%e7%a2%98%e4%bc%8f%e6%88%96%e8%8e%ab","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=24835","title":{"rendered":"[JAMA\u53d1\u8868\u8bba\u6587]\uff1a\u6d17\u5fc5\u6cf0\u6c90\u6d74\u6761\u4ef6\u4e0b\u9f3b\u90e8\u4f7f\u7528\u7898\u4f0f\u6216\u83ab\u5339\u7f57\u661f\u9884\u9632\u6210\u4ebaICU\u4e2d\u7684\u611f\u67d3"},"content":{"rendered":"\n

Original Investigation <\/p>\n\n\n\n

Caring for the Critically Ill Patient<\/p>\n\n\n\n

October 10, 2023<\/p>\n\n\n\n

Nasal Iodophor Antiseptic vs Nasal Mupirocin Antibiotic in the Setting of Chlorhexidine Bathing to Prevent Infections in Adult ICUs: A Randomized Clinical Trial<\/h1>\n\n\n\n

Susan S. Huang, Edward J. Septimus, Ken Kleinman, et al<\/h3>\n\n\n\n

JAMA. <\/em>2023;330(14):1337-1347. doi:10.1001\/jama.2023.17219<\/h3>\n\n\n\n

<\/a>Key Points<\/p>\n\n\n\n

Question<\/strong>  Does nasal iodophor antiseptic work as well as nasal mupirocin antibiotic for preventing Staphylococcus aureus<\/em>clinical cultures in intensive care unit (ICU) patients receiving daily chlorhexidine bathing?<\/p>\n\n\n\n

Findings<\/strong>  In this noninferiority, cluster randomized trial of 801\u202f668 admissions at 137 hospitals, exposure to nasal mupirocin significantly reduced S aureus<\/em> clinical cultures by 18.4% compared with iodophor in adult ICUs in the context of daily chlorhexidine bathing.<\/p>\n\n\n\n

Meaning<\/strong>  Nasal iodophor antiseptic did not meet criteria to be considered noninferior to nasal mupirocin antibiotic for the outcome of S aureus<\/em> clinical cultures in adult ICU patients in the context of daily CHG bathing. In addition, the results were consistent with nasal iodophor being inferior to nasal mupirocin.<\/a><\/p>\n\n\n\n

Abstract<\/p>\n\n\n\n

Importance<\/strong>  Universal nasal mupirocin plus chlorhexidine gluconate (CHG) bathing in intensive care units (ICUs) prevents methicillin-resistant Staphylococcus aureus<\/em> (MRSA) infections and all-cause bloodstream infections. Antibiotic resistance to mupirocin has raised questions about whether an antiseptic could be advantageous for ICU decolonization.<\/p>\n\n\n\n

Objective<\/strong>  To compare the effectiveness of iodophor vs mupirocin for universal ICU nasal decolonization in combination with CHG bathing.<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>  Two-group noninferiority, pragmatic, cluster-randomized trial conducted in US community hospitals, all of which used mupirocin-CHG for universal decolonization in ICUs at baseline. Adult ICU patients in 137 randomized hospitals during baseline (May 1, 2015-April 30, 2017) and intervention (November 1, 2017-April 30, 2019) were included.<\/p>\n\n\n\n

Intervention<\/strong>  Universal decolonization involving switching to iodophor-CHG (intervention) or continuing mupirocin-CHG (baseline).<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong>  ICU-attributable S aureus<\/em> clinical cultures (primary outcome), MRSA clinical cultures, and all-cause bloodstream infections were evaluated using proportional hazard models to assess differences from baseline to intervention periods between the strategies. Results were also compared with a 2009-2011 trial of mupirocin-CHG vs no decolonization in the same hospital network. The prespecified noninferiority margin for the primary outcome was 10%.<\/p>\n\n\n\n

Results<\/strong>  Among the 801\u202f668 admissions in 233 ICUs, the participants\u2019 mean (SD) age was 63.4 (17.2) years, 46.3% were female, and the mean (SD) ICU length of stay was 4.8 (4.7) days. Hazard ratios (HRs) for S aureus<\/em> clinical isolates in the intervention vs baseline periods were 1.17 for iodophor-CHG (raw rate: 5.0 vs 4.3\/1000 ICU-attributable days) and 0.99 for mupirocin-CHG (raw rate: 4.1 vs 4.0\/1000 ICU-attributable days) (HR difference in differences significantly lower by 18.4% [95% CI, 10.7%-26.6%] for mupirocin-CHG, P<\/em>\u2009<\u2009.001). For MRSA clinical cultures, HRs were 1.13 for iodophor-CHG (raw rate: 2.3 vs 2.1\/1000 ICU-attributable days) and 0.99 for mupirocin-CHG (raw rate: 2.0 vs 2.0\/1000 ICU-attributable days) (HR difference in differences significantly lower by 14.1% [95% CI, 3.7%-25.5%] for mupirocin-CHG, P<\/em>\u2009=\u2009.007). For all-pathogen bloodstream infections, HRs were 1.00 (2.7 vs 2.7\/1000) for iodophor-CHG and 1.01 (2.6 vs 2.6\/1000) for mupirocin-CHG (nonsignificant HR difference in differences, \u22120.9% [95% CI, \u22129.0% to 8.0%]; P<\/em>\u2009=\u2009.84). Compared with the 2009-2011 trial, the 30-day relative reduction in hazards in the mupirocin-CHG group relative to no decolonization (2009-2011 trial) were as follows: S aureus<\/em> clinical cultures (current trial: 48.1% [95% CI, 35.6%-60.1%]; 2009-2011 trial: 58.8% [95% CI, 47.5%-70.7%]) and bloodstream infection rates (current trial: 70.4% [95% CI, 62.9%-77.8%]; 2009-2011 trial: 60.1% [95% CI, 49.1%-70.7%]).<\/p>\n\n\n\n

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Conclusions and Relevance<\/strong>  Nasal iodophor antiseptic did not meet criteria to be considered noninferior to nasal mupirocin antibiotic for the outcome of S aureus<\/em> clinical cultures in adult ICU patients in the context of daily CHG bathing. In addition, the results were consistent with nasal iodophor being inferior to nasal mupirocin.<\/p>\n\n\n\n

Trial Registration<\/strong>  ClinicalTrials.gov Identifier: NCT03140423<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation  Caring for the Critically […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/24835"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=24835"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/24835\/revisions"}],"predecessor-version":[{"id":24838,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/24835\/revisions\/24838"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=24835"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=24835"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=24835"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}