SWAP OUT

SWAP OUT  SWAP OUT

Intensive care units (ICUs) have one of the highest rates of healthcare-associated infections due the patients’ severity of illness and frequent use of medical devices. The previously conducted REDUCE MRSA Trial showed that ICUs using chlorhexidine (CHG) antiseptic for routine daily bathing and mupirocin antibiotic for nasal decolonization of all admissions experienced a significant reduction in (MRSA) clinical cultures and all-cause bloodstream infections. Nasal mupirocin has been shown to be important because CHG does not clear the nasal reservoir of S. aureus, one of the most common and virulent healthcare-associated pathogens.

In order to avert the increased mupirocin resistance found during the 18 month period of the REDUCE MRSA trial, alternative agents that do not readily engender resistance are needed. The phenomenon of resistance emerging with use has been observed for many antibiotics. In contrast, antiseptics, such as alcohol, iodophor, and CHG, have not been shown to engender clinically meaningful resistance. Continuing our work with the Hospital Corporation of America (HCA), the SWAPOUT trial will evaluate the ability of a nasal antiseptic to perform similarly to mupirocin when used in combination with CHG for universal ICU decolonization. This trial will be the first large-scale comparison of intranasal antibiotic vs antiseptic as components of a standard decolonization regimen with CHG. It will be conducted as a pragmatic comparative effectiveness trial in up to 140 community hospitals, and thus have immediate applicability to the most U.S. hospitals.

PUBLICATIONS

Septimus EJ, Hickok J, Moody J, Kleinman K, Avery TR, Huang SS, Platt R, Perlin J (2015). Closing the Translation Gap: Toolkit Based Implementation of Universal Decolonization in Adult Intensive Care Units Reduces Central Line Associated Bloodstream Infections in 95 Community Hospitals. Clinical Infectious Disease, published online May 2016.

Hayden MK, Lolans K, Haffenreffer K, Avery TR, Kleinman K, Li H, Kaganov RE, Lankiewicz J, Moody J, Septimus E, Weinstein RA, Hickok J, Jernigan J, Perlin JB, Platt R, Huang SS and the CDC Prevention Epicenters Program and the AHRQ DECIDE Network and Healthcare-Associated Infections Program (2015). Chlorhexidine and Mupirocin Susceptibility of Methicillin-Resistant Staphylococcus aureus Isolates in the REDUCE-MRSA Trial. J Clin Microbiol. 2016 Nov;54(11):2735-2742. Epub 2016 Aug 24

Huang SS, Septimus EJ, Hayden MK, Kleinman K, Avery TR, Moody J, Hickok J, Lankiewicz J, Gombosev A, Kaganov RE, Haffenreffer K, Jernigan JA, Perlin JB, Platt R, Weinstein RA and the CDC Prevention Epicenters Program and the AHRQ DECIDE Network and Healthcare-Associated Infections Program (2015). Effect of Body Surface Decolonization on Bacteriuria and Candiduria in Intensive Care Units; an Analysis of a Cluster-Randomized Trial. The Lancet Infectious Diseases, published online November 2015.

Huang SS, Septimus EJ, Avery TR, Lee GM, Hickok J, Weinstein RA, Moody J, Hayden MK, Perlin JB, Platt R, Ray GT (2014). Cost savings of universal decolonization to prevent intensive care unit infection: implications of the REDUCE MRSA trial. Infection Control and Hospital Epidemiology. 2014 Oct;35(S3), S23-31. http://www.jstor.org/stable/10.1086/677819

Septimus EJ, Hayden MK, Kleinman K, Avery TR, Moody J, Weinstein RA, Hickok J, Lankiewicz J, Gombosev A, Haffenreffer K, Kaganov RE, Jernigan JA, Perlin JB, Platt R, Huang SS and the CDC Prevention Epicenters Program and the AHRQ DEcIDE Network and Healthcare-Associated Infections Program (2014). Does Chlorhexidine Bathing in Adult Intensive Care Units Reduce Blood Culture Contamination? A Pragmatic Cluster-Randomized Trial. Infection Control and Hospital Epidemiology. 2014 Oct;35(S3), S17-S22. http://www.jstor.org/stable/10.1086/677822

Huang SS, Septimus E, Kleinman K, Moody J, Hickock J, Avery T, Lankiewicz J, Gombosev A, Terpstra L, Hartford F, Hayden M, Jernigan J, Weinstein R, Fraser V, Haffenreffer K, Cui E, Kaganov E, Lolans K, Perlin J, Platt R and the CDC Prevention Epicenters Program the AHRQ DECIDE Network and Healthcare-Associated Infections Program (2013). Targeted versus Universal Decolonization to Prevent ICU Infection. New England Journal of Medicine, 368(24), 2255-2265.  http://www.nejm.org/doi/full/10.1056/NEJMoa1207290

Platt R, Takvorian SU, Septimus E, Hickok J, Moody J, Perlin J, Jernigan, JA, Kleinman K, Huang SS (2010). Cluster randomized trials in comparative effectiveness research: randomizing hospitals to test methods for prevention of healthcare-associated infections. Medical Care. 2010 Jun;48(6), S52-S57.


Principal Investigators: Susan Huang, MD, MPH, Richard Platt, MD, MSc

Funder: Centers for Disease Control and Prevention