Hostname: page-component-78c5997874-v9fdk Total loading time: 0 Render date: 2024-11-17T23:27:43.942Z Has data issue: false hasContentIssue false
  • English
  • Français

Randomized Comparison of 2 Protocols to Prevent Acquisition of Methicillin-Resistant Staphylococcus aureus: Results of a 2-Center Study Involving 500 Patients

Published online by Cambridge University Press:  02 January 2015

Christophe Camus ,
Eric Bellissant ,
Annick Legras ,
Alain Renault ,
Arnaud Gacouin ,
Sylvain Lavoué ,
Bernard Branger ,
Pierre-Yves Donnio ,
Pascal le Corre  and
Yves Le Tulzo
...Show all authors
Christophe Camus*
Affiliation:
Medical Intensive Care Department, Pontchaillou Hospital, Rennes 1 University, Rennes, France INSERM 0203 Clinical Investigation Centre, Pontchaillou Hospital, Rennes 1 University, Rennes, France
Eric Bellissant
Affiliation:
Clinical Pharmacology Department, Pontchaillou Hospital, Rennes 1 University, Rennes, France INSERM 0203 Clinical Investigation Centre, Pontchaillou Hospital, Rennes 1 University, Rennes, France
Annick Legras
Affiliation:
Medical Intensive Care Department, Bretonneau Hospital, Tours University, Tours, France
Alain Renault
Affiliation:
Clinical Pharmacology Department, Pontchaillou Hospital, Rennes 1 University, Rennes, France INSERM 0203 Clinical Investigation Centre, Pontchaillou Hospital, Rennes 1 University, Rennes, France
Arnaud Gacouin
Affiliation:
Medical Intensive Care Department, Pontchaillou Hospital, Rennes 1 University, Rennes, France
Sylvain Lavoué
Affiliation:
Medical Intensive Care Department, Pontchaillou Hospital, Rennes 1 University, Rennes, France
Bernard Branger
Affiliation:
Public Health Department, Pontchaillou Hospital, Rennes 1 University, Rennes, France
Pierre-Yves Donnio
Affiliation:
Microbiology Department, Pontchaillou Hospital, Rennes 1 University, Rennes, France
Pascal le Corre
Affiliation:
Pharmacy Department, Pontchaillou Hospital, Rennes 1 University, Rennes, France
Yves Le Tulzo
Affiliation:
Medical Intensive Care Department, Pontchaillou Hospital, Rennes 1 University, Rennes, France
Dominique Perrotin
Affiliation:
Medical Intensive Care Department, Bretonneau Hospital, Tours University, Tours, France
Rémi Thomas
Affiliation:
Medical Intensive Care Department, Pontchaillou Hospital, Rennes 1 University, Rennes, France
*
Service de Maladies Infectieuses et Réanimation Médicale, Hôpital de Pontchaillou, 2 rue Henri Le Guilloux, 35033 Rennes Cedex, France (christophe.camus@chu-rennes.fr)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To compare an interventional protocol with a standard protocol for preventing the acquisition of methicillin-resistant Staphylococcus aureus (MRSA) in the intensive care unit (ICU).

Design.

Prospective, randomized, controlled, parallel-group, nonblinded clinical trial.

Setting.

Medical ICUs of 2 French university hospitals.

Participants.

Five hundred adults with an expected length of stay in the ICU greater than 48 hours.

Interventions.

For the intervention group, the protocol required repeated MRSA screening, contact and droplet isolation precautions for patients at risk for MRSA at ICU admission and for MRSA-positive patients, and decontamination with nasal mupirocin and chlorhexidine body wash for MRSA-positive patients. For the standard group, the standard precautions protocol was used, and the results of repeated MRSA screening in the standard group were not communicated to investigators.

Main Outcome Measure.

MRSA acquisition rate in the ICU. An audit was conducted to assess compliance with hygiene and isolation precautions.

Results.

In the intent-to-treat analysis (n = 488), the MRSA acquisition rate in the ICU was similar in the standard (13 [5.3%] of 243) and intervention (16 [6.5%] of 245) groups (P =.58). The audit showed that the overall compliance rate was 85.5% in the standard group and 84.1% in the intervention group (P =.63), although compliance was higher when isolation precautions were absent than when they were in place (88.2% vs 79.1%; P<.001). MRSA incidence rates were higher without isolation precautions (7.57‰) than with isolation precautions (2.36‰; P =.01).

Conclusions.

Individual allocation to MRSA screening, isolation precautions, and decontamination do not provide individual benefit in reducing MRSA acquisition, compared with standard precautions, although the collective risk was lower during the periods of isolation.

Trial Registration.

Clinicaltrials.gov identifier: NCT00151606.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 11 , November 2011 , pp. 1064 - 1072
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Legras, A, Malvy, D, Quinioux, AI, et al. Nosocomial infections: prospective survey of incidence in five French intensive care units. Intensive Care Med 1998;24:1040–1046.CrossRefGoogle ScholarPubMed
2.Vincent, JL, Bihari, DJ, Suter, PM, et al. The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) study. JAMA 1995;274:639–644.CrossRefGoogle ScholarPubMed
3.Garner, JS; The Hospital Infection Control Practices Advisory Committee. Guideline for isolation precautions in hospitals. Infect Control Hosp Epidemiol 1996;17:53–80.CrossRefGoogle ScholarPubMed
4.Fridkin, S, Gaynes, R. Antimicrobial resistance in intensive care units. Clin Chest Med 1999;20:303–316.CrossRefGoogle ScholarPubMed
5.National Nosocomial Infections Surveillance (NNIS) system report, data summary from January 1992 through June 2003, issued August 2003. Am J Infect Control 2003;31:481–498.Google Scholar
6.McDougal, LK, Steward, CD, Killgore, GE, Chaitram, JM, McAllister, SK, Tenover, FC. Pulsed-field gel electrophoresis typing of oxacillin-resistant Staphylococcus aureus isolates from the United States: establishing a national database. Clin Microbiol 2003;41:5113–5120.CrossRefGoogle ScholarPubMed
7.Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L; the Healthcare Infection Control Practices Advisory Committee. Management of multidrug-resistant organisms in healthcare settings, 2006. http://www.cdc.gov/ncidod/dhqp/pdf/ar/mdroGuideline2006.pdf.CrossRefGoogle Scholar
8.Robicsek, A, Beaumont, JL, Paule, SM, et al. Universal surveillance for methicillin-resistant Staphylococcus aureus in 3 affiliated hospitals. Ann Intern Med 2008;148:409–418.CrossRefGoogle ScholarPubMed
9.Le Gall, JR, Lemeshow, S, Saulnier, F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 1993;270:2957–2963.CrossRefGoogle ScholarPubMed
10.Camus, C, Bellissant, E, Sebille, V, et al. Prevention of acquired infections in intubated patients with the combination of two decontamination regimens. Crit Care Med 2005;33:307–314.CrossRefGoogle ScholarPubMed
11.Centers for Disease Control and Prevention. Guideline for isolation precautions in hospitals. Am J Infect Control 1996;2 4: 24–52.Google Scholar
12.Comité de l'Antibiogramme de la Société Française de Microbiologie report 2003. Members of the SFM Antibiogram Committee. Int J Antimicrob Agents. 2003;21:364–391.Google Scholar
13.Gould, IM. The clinical significance of methicillin-resistant Staphylococcus aureus. J Hosp Infect 2005;61:277–282.CrossRefGoogle ScholarPubMed
14.Boyce, JM, Havill, NL, Kohan, C, Dumigan, DG, Ligi, CE. Do infection control measures work for methicillin-resistant Staphylococcus aureus? Infect Control Hosp Epidemiol 2004;25:395–401.CrossRefGoogle ScholarPubMed
15.Gould, IM, MacKenzie, FM, MacLennan, G, Pacitti, D, Watson, EJ, Noble, DW. Topical antimicrobials in combination with admission screening and barrier precautions to control endemic methicillin-resistant Staphylococcus aureus in an intensive care unit. Int J Antimicrob Agents 2007;29:536–543.CrossRefGoogle Scholar
16.Pan, A, Carnevale, G, Catenazzi, P, et al. Trends in methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections: effect of the MRSA “search and isolate” strategy in a hospital in Italy with hyperendemic MRSA. Infect Control Hosp Epidemiol 2005;26:127–133.CrossRefGoogle Scholar
17.Raineri, E, Crema, L, De Silvestri, A, et al. Methicillin-resistant Staphylococcus aureus control in an intensive care unit: a 10 year analysis. J Hosp Infect 2007;67:308–315.CrossRefGoogle Scholar
18.Lucet, JC, Paoletti, X, Lolom, I, et al. Successful long-term program for controlling methicillin-resistant Staphylococcus aureus in intensive care units. Intensive Care Med 2005;31:1051–1057.Google Scholar
19.Huang, SS, Yokoe, DS, Hinrichsen, VL, et al. Impact of routine intensive care unit surveillance cultures and resultant barrier precautions on hospital-wide methicillin-resistant Staphylococcus aureus bacteremia. Clin Infect Dis 2006;43:971–978.CrossRefGoogle ScholarPubMed
20.Torgerson, DJ. Contamination in trials: is cluster randomisation point the answer? BMJ 2001;322:355–357.CrossRefGoogle Scholar
21.Slymen, DJ, Hovell, MF. Cluster versus individual randomization in adolescent tobacco and alcohol studies: illustrations for design decisions. Int J Epidemiol 1997;26:765–771.CrossRefGoogle ScholarPubMed
22.Johnson, PD, Martin, R, Burreil, LJ, et al. Efficacy of an alcohol/Chlorhexidine hand hygiene program in a hospital with high rates of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection. Med J Aust 2005;183:509–514.CrossRefGoogle Scholar
23.Pittet, D, Hugonnet, S, Harbarth, S, et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene (published correction appears in Lancet 2000;356:2196). Lancet 2000;356:1307–1312.Google Scholar
24.Grayson, ML, Jarvie, LJ, Martin, R, et al. Significant reductions in methicillin-resistant Staphylococcus aureus bacteraemia and clinical isolates associated with a multisite, hand hygiene culture-change program and subsequent successful statewide roll-out. Med J Aust 2008;188:633–640.CrossRefGoogle ScholarPubMed
25.Pittet, D, Mourouga, P, Perneger, TV. Compliance with handwashing in a teaching hospital. Ann Intern Med 1999;130:126–130.CrossRefGoogle ScholarPubMed
26.Ridenour, GA, Wong, ES, Call, MA, Climo, MW. Duration of colonization with methicillin-resistant Staphylococcus aureus among patients in the intensive care unit: implications for intervention. Infect Control Hosp Epidemiol 2006;27:271–278.CrossRefGoogle ScholarPubMed
27.Lucet, JC, Grenet, K, Armand-Lefevre, L, et al. High prevalence of carriage of methicillin-resistant Staphylococcus aureus at hospital admission in elderly patients: implications for infection control strategies. Infect Control Hosp Epidemiol 2005;26:121–126.CrossRefGoogle ScholarPubMed
28.Cooper, BS, Stoné, SP, Kibbler, CC, et al. Isolation measures in the hospital management of methicillin resistant Staphylococcus aureus (MRSA): systematic review of the literature. BMJ 2004;329(7465):533–538.CrossRefGoogle ScholarPubMed
29.Troché, G, Joly, LM, Guibert, M, Zazzo, JF. Detection and treatment of antibiotic-resistant bacterial carriage in a surgical intensive care unit: a 6-year prospective survey. Infect Control Hosp Epidemiol 2005;26:161–165.Google Scholar
30.Harbarth, S, Fankhauser, C, Schrenzel, J, et al. Universal screening for methicillin-resistant Staphylococcus aureus at hospital admission and nosocomial infection in surgical patients. JAMA 2008;299:1149–1157.Google Scholar
31.Edmond, MB, Ober, JF, Bearman, G. Active surveillance cultures are not required to control MRSA infections in the critical care setting. Am J Infect Control 2008;36:461–463.CrossRefGoogle Scholar
32.Jernigan, JA, Titus, MG, Gröschel, DH, Getchell-White, S, Farr, BM. Effectiveness of contact isolation during a hospital outbreak of methicillin-resistant Staphylococcus aureus. Am J Epidemiol 1996;143:496–504.Google Scholar
33.Mangini, E, Segal-Maurer, S, Burns, J, et al. Impact of contact and droplet precautions on the incidence of hospital-acquired methicillin-resistant Staphylococcus aureus infection. Infect Control Hosp Epidemiol 2007;28:1261–1266.CrossRefGoogle ScholarPubMed
34.Harbarth, S, Dharan, S, Liassine, N, Herrault, P, Auckenthaler, R, Pittet, D. Randomized, placebo-controlled, double-blind trial to evaluate the efficacy of mupirocin for eradicating carriage of methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother 1999;43:1412–1416.CrossRefGoogle ScholarPubMed
35.Harbarth, S, Liassine, N, Dharan, S, Herrault, P, Auckenthaler, R, Pittet, D. Risk factors for persistent carriage of methicillin-resistant Staphylococcus aureus. Clin Infect Dis 2000;31:1380–1385.CrossRefGoogle ScholarPubMed
36.Climo, MW, Sepkowitz, KA, Zuccotti, G, et al. The effect of daily bathing with Chlorhexidine on the acquisition of methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and healthcare-associated bloodstream infections: results of a quasi-experimental multicenter trial. Crit Care Med 2009;37: 1858–1865.Google Scholar
37.Wendt, C, Schinke, S, Württemberger, M, Oberdorfer, K, Bock-Hensley, O, von Baum, H. Value of whole-body washing with Chlorhexidine for the eradication of methicillin-resistant Staphylococcus aureus: a randomized, placebo-controlled, double-blind clinical trial. Infect Control Hosp Epidemiol 2007;28: 1036–1043.CrossRefGoogle ScholarPubMed
38.Ridenour, G, Lampen, R, Federspiel, J, Kritchevsky, S, Wong, E, Climo, M. Selective use of intranasal mupirocin and Chlorhexidine bathing and the incidence of methicillin-resistant Staphylococcus aureus colonization and infection among intensive care unit patients. Infect Control Hosp Epidemiol 2007;28:1155–1161.Google Scholar