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May 29, 2013

MRSA study slashes deadly infections in sickest hospital patients

Bloodstream infections cut by more than 40 percent in study of over 74,000 patients

Using germ-killing soap and ointment on all intensive-care unit (ICU) patients can reduce bloodstream infections by up to 44 percent and significantly reduce the presence of methicillin-resistant Staphylococcus aureus (MRSA) in ICUs, according study results published in today’s New England Journal of Medicine.

The REDUCE MRSA trial, funded by the Department of Health and Human Services, was conducted in two stages from 2009-2011. It tested three MRSA prevention strategies and found that using germ-killing soap and ointment on all ICU patients was more effective than other strategies.

“The strategy that proved to be most effective was perhaps the most straightforward: All patients were bathed daily with chlorhexidine antiseptic soap for the duration of their ICU stay and all received mupirocin antibiotic ointment applied in the nose for five days,” said Dr. Mary Hayden, associate professor of infectious diseases and pathology at Rush University Medical Center, and one of the co-authors of the study.

"This approach proved to be more effective than screening intensive care unit (ICU) patients for the bacteria and then focusing on those identified as carriers.

MRSA is resistant to first-line antibiotic treatments and is an important cause of illness and sometimes death, especially among patients who have had medical care.  Three-quarters of Staphylococcus aureus infections in hospital ICUs are considered methicillin-resistant. In 2012, encouraging results from a CDC report showed that invasive (life-threatening) MRSA infections in hospitals declined by 48 percent from 2005 through 2010.

“In ICUs, these infections are generally caused by increasingly antibiotic-resistant bacteria that for most people live harmlessly on the skin or, particularly in the case of MRSA, in the nose,” said Dr. Robert Weinstein, a co-author of the study. He is professor of medicine at Rush University, and chair of the Department of Medicine of John H. Stroger, Jr. Hospital of Cook County.

“These are often preventable infections that can cause serious complications for patients. These results are critical when assessing whether other measures, either targeted or universal, would have greater impact,” Weinstein said. “The universal approach was clearly superior.”

A multidisciplinary team from the University of California, Irvine, Harvard Pilgrim Health Care Institute, Hospital Corporation of America (HCA) and the Centers for Disease Control and Prevention (CDC) carried out the study.  A total of 74 adult ICUs and 74,256 patients were part of the study, making it the largest study on this topic.

Researchers evaluated the effectiveness of three MRSA prevention practices: routine care, providing germ-killing soap and ointment only to patients with MRSA, and providing germ-killing soap and ointment to all ICU patients. In addition to being effective at stopping the spread of MRSA in ICUs, the study found the use of germ-killing soap and ointment on all ICU patients was also effective for preventing infections caused by germs other than MRSA.

The authors believe this study helps answer a long-standing debate in the medical field about whether to should tailor their efforts to prevent infection to specific pathogens, such as MRSA, or whether they should identify a high-risk patient group and give them all special treatment to prevent infection. The universal decolonization strategy proved to be the most effective and the easiest to implement, and it eliminates the need for screening ICU patients for MRSA.



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