SWAP OUT

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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. However, a major concern about widespread mupirocin use is the potential to led to increased resistance, a phenomenon that has been observed for many antibiotics.  As such, alternative agents that do not readily promote resistance are needed. In particular, antiseptics, such as alcohol, iodophor, and CHG, have not been shown to induce clinically meaningful resistance. Continuing our work with HCA Healthcare, the SWAPOUT trial was the first large-scale comparison of the ability of a nasal antiseptic to perform similarly to mupirocin when used in combination with CHG for universal ICU decolonization. It was conducted as a pragmatic comparative effectiveness trial in 140 community hospitals, and thus has immediate applicability to most U.S. hospitals. An abstract describing the trial results was presented at the IDWeek 2021 conference, with the publication pending journal acceptance.

PUBLICATIONS AND/OR PRESENTATIONS

Huang SS, Septimus E, Kleinman K, Heim L, Moody J, Avery TR, McLean L, Rashid S, Haffenreffer K, Shimelman L, Staub-Juergens W, Spencer-Smith C, Sljivo S, Rosen E, Poland R, Coady MH, Blanchard EJ, Reddish K, Hayden MK, Weinstein RA, Carver B, Lolans K, Kahn N, Sturdevant SG, Reddy S, Jernigan JA, Sands KE, Perlin J, Platt R. 137 hospital cluster-randomized trial of mupirocin-chlorhexidine vs iodophor-chlorhexidine for universal decolonization in Intensive Care Units (ICUs) (Mupirocin Iodophor Swap Out Trial). Oral Presentation. ID Week 2021 virtual conference.

Huang SS, Septimus E, Kleinman K, Moody J, Hickok J, Heim L, Gombosev A, Avery TR, Haffenreffer K, Shimelman L, Hayden MK, Weinstein RA, Spencer-Smith C, Kaganov RE, Murphy MV, Forehand T, Lankiewicx J, Coady MH, Portillo L, Sarup-Patel J, Jernigan JA, Perlin JB, Platt R. ABATE Infection trial team. Chlorhexidine versus routine bathing to prevent multidrug-resistant organisms and all-cause bloodstream infection in general medical surgical units (ABATE Infection trial): a cluster-randomised trial.  Lancet 393(10177):1205-1215. Published online March 5, 2019, in print March 23, 2019.

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

Moody J, Septimus E, Hickok J, Huang SS, Platt R, Gombosev A, Terpstra L, Avery T, Lankiewicz J, Perlin JB. Infection prevention practices in adult intensive care units in a large community hospital system after implementing strategies to reduce health care-associated, methicillin-resistant Staphylococcus aureus infections. Am J Infect Control 41(2):126-30. doi: 10.1016/j.ajic.2012.02.017. Published online June 29, 2012, in print February 2013.

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.


Funders: Centers for Disease Control and Prevention, Agency for Healthcare Research and Quality, NIH Health Care Systems (HCS) Research Collaboratory