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1450Impact of Body Surface Decolonization on Bacteriuria and Candiduria in a Cluster-Randomized Trial of Intensive Care Units

Year: 2014

Type: conference-abstract

Abstract: Background. Bacteriuria commonly precedes UTI, and is often treated with antibiotics, especially in ICU patients. The impact of body surface decolonization on bacteriuria and candiduria is unknown. Methods. Secondary analysis of a 3 arm cluster randomized trial of 43 hospitals (74 adult ICUs). Arms included 1) MRSA screening and isolation, 2) targeted decolonization: screening, isolation, and decolonization of MRSA carriers with chlorhexidine (CHG) and mupirocin, and 3) universal decolonization: no screening, all patients decolonized. Protocol included CHG cleansing of the perineum and proximal 6” of urinary catheters. Outcomes included high-level (HL) bacteriuria (>50K colony forming units (CFU)/ml) with uropathogens, HL candiduria (>50K CFU/ml), and any bacteriuria with uropathogens. Gender analyses were pre-specified. Proportional hazards models assessed differences in reductions across arms comparing18-month intervention to a 12-month baseline, clustering by hospital. Results. There were 48,390 patients in the baseline period; 74,256 patients in the intervention period. Hazard ratios (HR) for HL bacteriuria were 1.02 for screening/isolation, 0.88 for targeted decolonization, and 0.87 for universal decolonization (P = 0.26), with no gender-specific reductions (Men: Screening/isolation: HR = 1.09; targeted decolonization: HR = 1.01; and universal decolonization: HR = 0.78; P = 0.12). HRs for HL candiduria were 1.1 for screening/isolation, 0.99 for targeted decolonization, and 0.83 for universal decolonization (P = 0.05), and was due to reductions in men in the universal decolonization arm (Screening/isolation: HR = 1.21; targeted decolonization: HR = 1.01; and universal decolonization: HR = 0.63; P = 0.02). Bacteriuria with any CFU/ml was also reduced in men in the universal decolonization arm (Screening/isolation: HR = 1.01; targeted decolonization: HR = 1.02; and universal decolonization: HR = 0.74; P = 0.04). Conclusion. Universal decolonization of ICU patients was associated with significant declines in candiduria and any bacteriuria among men, but not women, in a secondary analysis of a large cluster randomized trial. Reductions in HL bacteriuria were not significant, although similar point estimate reductions were seen in men. Disclosures. S. S. Huang, Sage Products: Conducting clinical trial for which contributed product is being provided to participating hospitals, Contributed Product; Molnlycke: Conducting clinical trial for which contributed product is being provided to participating hospitals, Contributed product E. Septimus, Sage and Molnlyke: received product, provided product for ABATE study; AHRQ, CDC, NIH: Grant Investigator, Grant recipient M. K. Hayden, Sage Products: Conducting clinical trial for which contributed product is being provided to participating hospitals, Contributed Product; Molnlycke: Conducting clinical trial for which contributed product is being provided to participating hospitals, Contributed product K. Kleinman, Sage Products: Conducting clinical trial for which contributed product is being provided to participating hospitals, Contributed Product Molnlycke: Conducting clinical trial for which contributed product is being provided to participating hospitals, Contributed product T. Avery, Sage Products: Conducting clinical trial for which contributed product is being provided to participating hospitals, Contributed Product; Molnlycke: Conducting clinical trial for which contributed product is being provided to participating hospitals, Contributed product J. Moody, Sage Products: Conducting clinical trial for which contributed product is being provided to participating hospitals, Contributed Product; Molnlycke: Conducting clinical trial for which contributed product is being provided to participating hospitals, Contributed product J. Hickok, Sage Products: Conducting clinical trial for which contributed product is being provided to participating hospitals, Contributed Product; Molnlycke: Conducting clinical trial for which contributed product is being provided to participating hospitals, Contributed product J. Lankiewicz, Sage Products: Conducting clinical trial for which contributed product is being provided to participating hospitals, Contributed Product; Molnlycke: Conducting clinical trial for which contributed product is being provided to participating hospitals, Contributed product A. Gombosev, Sage Products: Conducting clinical trial for which contributed product is being provided to participating hospitals, Contributed Product; Molnlycke: Conducting clinical trial for which contributed product is being provided to participating hospitals, Contributed product R. E. Kaganov, Sage Products: Conducting clinical trial for which contributed product is being provided to participating hospitals, Contributed Product; Molnlycke: Conducting clinical trial for which contributed product is being provided to participating hospitals, Contributed product K. Haffenreffer, Sage Products: Conducting clinical trial for which contributed product is being provided to participating hospitals, Contributed Product; Molnlycke: Conducting clinical trial for which contributed product is being provided to participating hospitals, Contributed product J. Jernigan, Sage Products: Conducting clinical trial for which contributed product is being provided to participating hospitals, Contributed Product; Molnlycke: Conducting clinical trial for which contributed product is being provided to participating hospitals, Contributed product J. Perlin, Sage Products: Conducting clinical trial for which contributed product is being provided to participating hospitals, Contributed Product; Molnlycke: Conducting clinical trial for which contributed product is being provided to participating hospitals, Contributed product R. A. Weinstein, Sage Products: Conducting clinical trial for which contributed product is being provided to participating hospitals, Contributed Product; Molnlycke: Conducting clinical trial for which contributed product is being provided to participating hospitals, Contributed product

Source: Open Forum Infectious Diseases

DOI: 10.1093/ofid/ofu052.996