Program Schedule

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

Session: Poster Abstract Session: Fungal Infections
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Posters
  • Huang - Bacteriuria Poster FINAL.pdf (967.8 kB)
  • 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-mo intervention to a 12-mo 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.

    Susan S. Huang, MD, MPH, FIDSA1, Edward Septimus, MD, FIDSA, FSHEA2, Mary K. Hayden, MD, FSHEA, FIDSA3, Ken Kleinman, ScD4, Jessica Sturtevant, M.S.5, Taliser Avery, M.S.5, Julia Moody, MS2, Jason Hickok, RN, MBA2, Julie Lankiewicz, MPH4, Adrijana Gombosev, B.S.6, Rebecca E. Kaganov, BA7, Katherine Haffenreffer, B.S.5, John Jernigan, MD, MS8, Jonathan Perlin, MD, PhD, MSHA, FACP, FACMI2, Richard Platt, MD MS4, Robert a. Weinstein, MD, FIDSA3 and AHRQ DEcIDE Network and Healthcare-Associated Infections Program and CDC Prevention Epicenters Program, (1)Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, CA, (2)Clinical Services Group, HCA Inc, Nashville, TN, (3)Department of Internal Medicine, Section of Infectious Diseases, Rush University Medical Center, Chicago, IL, (4)Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, (5)Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA, (6)Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, CA, (7)Harvard Pilgrim Health Care Institute, Boston, MA, (8)Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA

    Disclosures:

    S. S. Huang, Sage Products: Conducting a clinical trial for which contributed product is being provided to participating hospitals, Contributed Product
    Molnlycke: Conducting a 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 a clinical trial for which contributed product is being provided to participating hospitals, Contributed Product
    Molnlycke: Conducting a clinical trial for which contributed product is being provided to participating hospitals, Contributed product

    K. Kleinman, Sage Products: Conducting a clinical trial for which contributed product is being provided to participating hospitals, Contributed Product
    Molnlycke: Conducting a clinical trial for which contributed product is being provided to participating hospitals, Contributed product

    J. Sturtevant, None

    T. Avery, Sage Products: Conducting a clinical trial for which contributed product is being provided to participating hospitals, Contributed Product
    Molnlycke: Conducting a clinical trial for which contributed product is being provided to participating hospitals, Contributed product

    J. Moody, Sage Products: Conducting a clinical trial for which contributed product is being provided to participating hospitals, Contributed Product
    Molnlycke: Conducting a clinical trial for which contributed product is being provided to participating hospitals, Contributed product

    J. Hickok, Sage Products: Conducting a clinical trial for which contributed product is being provided to participating hospitals, Contributed Product
    Molnlycke: Conducting a clinical trial for which contributed product is being provided to participating hospitals, Contributed product

    J. Lankiewicz, Sage Products: Conducting a clinical trial for which contributed product is being provided to participating hospitals, Contributed Product
    Molnlycke: Conducting a clinical trial for which contributed product is being provided to participating hospitals, Contributed product

    A. Gombosev, Sage Products: Conducting a clinical trial for which contributed product is being provided to participating hospitals, Contributed Product
    Molnlycke: Conducting a clinical trial for which contributed product is being provided to participating hospitals, Contributed product

    R. E. Kaganov, Sage Products: Conducting a clinical trial for which contributed product is being provided to participating hospitals, Contributed Product
    Molnlycke: Conducting a clinical trial for which contributed product is being provided to participating hospitals, Contributed product

    K. Haffenreffer, Sage Products: Conducting a clinical trial for which contributed product is being provided to participating hospitals, Contributed Product
    Molnlycke: Conducting a clinical trial for which contributed product is being provided to participating hospitals, Contributed product

    J. Jernigan, Sage Products: Conducting a clinical trial for which contributed product is being provided to participating hospitals, Contributed Product
    Molnlycke: Conducting a clinical trial for which contributed product is being provided to participating hospitals, Contributed product

    J. Perlin, Sage Products: Conducting a clinical trial for which contributed product is being provided to participating hospitals, Contributed Product
    Molnlycke: Conducting a clinical trial for which contributed product is being provided to participating hospitals, Contributed product

    R. Platt, None

    R. A. Weinstein, Sage Products: Conducting a clinical trial for which contributed product is being provided to participating hospitals, Contributed Product
    Molnlycke: Conducting a clinical trial for which contributed product is being provided to participating hospitals, Contributed product

    See more of: Fungal Infections
    See more of: Poster Abstract Session

    Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

    Sponsoring Societies:

    © 2014, idweek.org. All Rights Reserved.

    Follow IDWeek