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.
OBJECTIVE
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.


CONCLUSIONS
Among our study cohort of intubated patients, the use of M/C significantly reduced MRSA AI.
Service de Maladies Infectieuses et Réanimation Médicale, Hôpital de Pontchaillou, Centre Hospitalier Universitaire (CHU) de Rennes, Université de Rennes 1, 2 rue Henri Le Guilloux, 35033, Rennes cedex, France, christophe.camus@chu-rennes.fr.
C
C
Camus
V
V
Sebille
A
A
Legras
B
B
Garo
A
A
Renault
P
P
Le Corre
P-Y
PY
Donnio
A
A
Gacouin
D
D
Perrotin
Y
Y
Le Tulzo
E
E
Bellissant
D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002710:Chlorhexidine / Q000627:therapeutic use*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D005602:France; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D007440:Intubation / Q000009:adverse effects*; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D016712:Mupirocin / Q000627:therapeutic use*; D010919:Placebos / Q000008:administration & dosage; D011113:Polymyxins / Q000627:therapeutic use; D013203:Staphylococcal Infections / Q000382:microbiology / Q000517:prevention & control*; D014031:Tobramycin / Q000627:therapeutic use; D016896:Treatment Outcome; D055815:Young Adult
D000900:Anti-Bacterial Agents; D010919:Placebos; D011113:Polymyxins; D016712:Mupirocin; D002710:Chlorhexidine; D014031:Tobramycin