Thread by @WellingtonICU

This week's @wellingtonICU #twitterjournal club is on the #ABATE infection trial in @TheLancet sciencedirect.com/science/articl…

The ABATE Infection trial was a cluster randomised trial of 53 hospitals comparing routine bathing to decolonisation with universal chlorhexidine and targeted nasal mupirocin in 194 non-critical care units.

189,081 patients were in a baseline observation period then 183,013 were in intervention group and 156,889 were in the routine care group

The intervention group underwent daily chlorhexidine bathing and mupiricon was given to known methicillin resistant Staphylococcus aureus carriers.

The primary endpoint was MRSA or VRE clinical cultures occurring
from 3 days into the unit stay to 2 days after leaving.

HR between intervention period and baseline period in the intervention group was 0.79 (0.73-0.87). HR between intervention period and baseline period in the routine group was 0.87 (0.79-0.95). There was no significant difference between these 2 HRs, P = 0.17.

In post hoc sub group analysis, for patients with medical devices there was a 37% significant reduction in MRSA and VRE infection rates and a significant 31% reduction in the rates of bloodstream infections

Here is what I think it all means and what we should do

No. 1: Routine care in the non-critical care setting is as good as daily chlorhexidine bathing +/- mupiricon in controlling MRSA and VRE in patients without medical devices.

No. 2: In patients with medical devices in the non-clinical care setting daily chlorhexidine bathing +/- mupiricon daily bathing maybe beneficial

No. 3: We should NOT implement daily chlorhexidine washing, rather we should continue routine care, in the NON critical-care setting.

No. 4: This should NOT change practice in the critical care setting

Here are some major uncertainties

No. 1: This trial cannot be used to assess needs for chlorhexidine bathing in a
critical care setting. Prior evidence suggests universal decolonisation may reduce rates of MRSA in critical care units:
nejm.org/doi/full/10.10…

No. 2: There was a low burden of MRSA and VRE within this trial, only 3%. It is possible that in higher risk groups routine bathing is more effective than routine care.

No. 3: This trial was not designed to look specifically in non-critical care patients with medical devices and the effect of daily bathing on this patient group is hypothesis-generating.

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