Nasal Iodophor Antiseptic vs Nasal Mupirocin Antibiotic in the Setting of Chlorhexidine Bathing to Prevent Infections in Adult Intensive Care Units (ICUs): A Randomized Clinical Trial
Primary result · S aureus clinical culturesResult — go to the resultHR difference in differences (lower for mupirocin-CHG) 18.4% 95% CI 10.7%–26.6%Authors' conclusion
Nasal iodophor antiseptic did not meet criteria to be considered noninferior to nasal mupirocin antibiotic for the outcome of S aureus 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.
Study context
- Population
- Adult ICU patients in US community hospitals using mupirocin-CHG universal decolonization at baseline
- Participants
- 801,668 admissions
- Comparison
- Mupirocin-CHG vs Iodophor-CHG
- Primary endpoint
- ICU-attributable S aureus clinical cultures
Methodological detailsnoninferiority, pragmatic, cluster-randomized, two-group, Baseline May 1, 2015-April 30, 2017; intervention November 1, 2017-April 30, 2019
- Noninferiority
- Pragmatic
- Cluster-randomized
- Two-group
- Baseline May 1, 2015-April 30, 2017; intervention November 1, 2017-April 30, 2019
Primary result
S aureus clinical cultures
HR difference in differences (lower for mupirocin-CHG)
18.4%
95% CI 10.7%–26.6%
P < 0.001
By group
Iodophor-CHG
5.0 vs 4.3
raw rate · /1000 ICU-attributable days
Mupirocin-CHG
4.1 vs 4.0
raw rate · /1000 ICU-attributable days
As reported in the abstract
Further findings
| Outcome | Iodophor-CHG | Mupirocin-CHG | HR difference in differences (95% CI) | P value | |
|---|---|---|---|---|---|
| All-pathogen bloodstream infections | raw rate 2.7 vs 2.7 /1000 | raw rate 2.6 vs 2.6 /1000 | −0.9% (−9.0% to 8.0%) | P = 0.84 | |
| HR intervention vs baseline period | 1.00 | 1.01 | |||
| −10−50510Difference (linear scale) |
| Outcome | Iodophor-CHG | Mupirocin-CHG | HR difference in differences (lower for mupirocin-CHG) (95% CI) | P value |
|---|---|---|---|---|
| MRSA clinical cultures | raw rate 2.3 vs 2.1 /1000 ICU-attributable days | raw rate 2.0 vs 2.0 /1000 ICU-attributable days | 14.1% (3.7%–25.5%) | P = 0.007 |
| HR intervention vs baseline period | 1.13 | 0.99 |
30-day relative reduction in hazards, mupirocin-CHG vs no decolonization (comparison with 2009-2011 trial)
- S aureus clinical cultures, current trial
- 48.1% [95% CI, 35.6%-60.1%]
- S aureus clinical cultures, 2009-2011 trial
- 58.8% [95% CI, 47.5%-70.7%]
- Bloodstream infection, current trial
- 70.4% [95% CI, 62.9%-77.8%]
- Bloodstream infection, 2009-2011 trial
- 60.1% [95% CI, 49.1%-70.7%]
Original publication
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