Use of standardized nasal and skin decolonization to reduce rates of bacteremia in patients undergoing extracorporeal membrane oxygenation
Abstract Objective: We aimed to determine if implementation of universal nasal decolonization with daily chlorhexidine bathing will decrease blood stream infections (BSI) in patients undergoing extracorporeal membrane oxygenation (ECMO). Design: Retrospective cohort study. Setting: Tertiary ca...
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| Format: | Article |
| Language: | English |
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Cambridge University Press
2025-01-01
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| Series: | Antimicrobial Stewardship & Healthcare Epidemiology |
| Online Access: | https://www.cambridge.org/core/product/identifier/S2732494X25000099/type/journal_article |
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| _version_ | 1823856589020332032 |
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| author | Madyson Taylor Russell L Griffin Jeremey Walker Catina James Angela Akinsanya Mary Duncan Rachael A Lee |
| author_facet | Madyson Taylor Russell L Griffin Jeremey Walker Catina James Angela Akinsanya Mary Duncan Rachael A Lee |
| author_sort | Madyson Taylor |
| collection | DOAJ |
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Abstract
Objective:
We aimed to determine if implementation of universal nasal decolonization with daily chlorhexidine bathing will decrease blood stream infections (BSI) in patients undergoing extracorporeal membrane oxygenation (ECMO).
Design:
Retrospective cohort study.
Setting:
Tertiary care facility.
Patients:
Patients placed on ECMO from January 1, 2017 to December 31, 2023.
Intervention:
Daily bathing with 4% chlorhexidine soap and universal mupirocin nasal decolonization were initiated for all ECMO patients May 2021. The primary outcome was rate of ECMO-attributable positive blood cultures. Zero-inflated Poisson regression analysis was performed to estimate rate ratios (RRs) for the association between decolonization with BSI rates.
Results:
A total of 776 patients met inclusion criteria during the study period, 425 (55%) preimplementation and 351 (45%) post-implementation. Following implementation of decolonization, the overall incidence rate of BSI increased nonsignificantly from 10.7 to 14.0 infections per 1000 ECMO days (aRR 1.09, 95% CI 0.74–1.59). For gram-positive cocci (GPC) pathogens, a nonsignificant 40% increased rate was observed in the post-implementation period (RR 1.40, 95% CI 0.89–2.21), due mostly to a significant increase in the crude rate of Enterococcus BSI (RR 1.89, 95% CI 1.01–3.55). Excluding Enterococcus resulted in a nonsignificant 28% decreased rate (aRR 0.72, 95% CI 0.39-1.36) due to a nonsignificant 55% decreased rate of MRSA (aRR 0.45, 95% CI 0.18–3.58).
Conclusions:
Implementation of a universal decolonization protocol did not significantly reduce rates of certain BSIs, including MRSA and other gram-positive pathogens. Although nonsignificant, reduction in BSI rates in this patient population has important implications on surveillance metrics, such as MRSA, and in the future, hospital-onset bacteremia.
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| format | Article |
| id | doaj-art-693a48f1299a4e58a1505b7324690f0c |
| institution | Kabale University |
| issn | 2732-494X |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | Antimicrobial Stewardship & Healthcare Epidemiology |
| spelling | doaj-art-693a48f1299a4e58a1505b7324690f0c2025-02-12T07:09:18ZengCambridge University PressAntimicrobial Stewardship & Healthcare Epidemiology2732-494X2025-01-01510.1017/ash.2025.9Use of standardized nasal and skin decolonization to reduce rates of bacteremia in patients undergoing extracorporeal membrane oxygenationMadyson Taylor0https://orcid.org/0000-0002-3593-3332Russell L Griffin1https://orcid.org/0000-0002-5004-7996Jeremey Walker2https://orcid.org/0000-0003-2920-4659Catina James3https://orcid.org/0000-0002-7839-0315Angela Akinsanya4Mary Duncan5Rachael A Lee6https://orcid.org/0000-0002-9701-8156Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USADepartment of Epidemiology, University of Alabama at Birmingham, Birmingham, AL USADepartment of Medicine, University of Alabama at Birmingham, Birmingham, AL, USADepartment of Infection Prevention, University of Alabama at Birmingham, Birmingham, AL, USADepartment of Infection Prevention, University of Alabama at Birmingham, Birmingham, AL, USADepartment of Infection Prevention, University of Alabama at Birmingham, Birmingham, AL, USADepartment of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA Abstract Objective: We aimed to determine if implementation of universal nasal decolonization with daily chlorhexidine bathing will decrease blood stream infections (BSI) in patients undergoing extracorporeal membrane oxygenation (ECMO). Design: Retrospective cohort study. Setting: Tertiary care facility. Patients: Patients placed on ECMO from January 1, 2017 to December 31, 2023. Intervention: Daily bathing with 4% chlorhexidine soap and universal mupirocin nasal decolonization were initiated for all ECMO patients May 2021. The primary outcome was rate of ECMO-attributable positive blood cultures. Zero-inflated Poisson regression analysis was performed to estimate rate ratios (RRs) for the association between decolonization with BSI rates. Results: A total of 776 patients met inclusion criteria during the study period, 425 (55%) preimplementation and 351 (45%) post-implementation. Following implementation of decolonization, the overall incidence rate of BSI increased nonsignificantly from 10.7 to 14.0 infections per 1000 ECMO days (aRR 1.09, 95% CI 0.74–1.59). For gram-positive cocci (GPC) pathogens, a nonsignificant 40% increased rate was observed in the post-implementation period (RR 1.40, 95% CI 0.89–2.21), due mostly to a significant increase in the crude rate of Enterococcus BSI (RR 1.89, 95% CI 1.01–3.55). Excluding Enterococcus resulted in a nonsignificant 28% decreased rate (aRR 0.72, 95% CI 0.39-1.36) due to a nonsignificant 55% decreased rate of MRSA (aRR 0.45, 95% CI 0.18–3.58). Conclusions: Implementation of a universal decolonization protocol did not significantly reduce rates of certain BSIs, including MRSA and other gram-positive pathogens. Although nonsignificant, reduction in BSI rates in this patient population has important implications on surveillance metrics, such as MRSA, and in the future, hospital-onset bacteremia. https://www.cambridge.org/core/product/identifier/S2732494X25000099/type/journal_article |
| spellingShingle | Madyson Taylor Russell L Griffin Jeremey Walker Catina James Angela Akinsanya Mary Duncan Rachael A Lee Use of standardized nasal and skin decolonization to reduce rates of bacteremia in patients undergoing extracorporeal membrane oxygenation Antimicrobial Stewardship & Healthcare Epidemiology |
| title | Use of standardized nasal and skin decolonization to reduce rates of bacteremia in patients undergoing extracorporeal membrane oxygenation |
| title_full | Use of standardized nasal and skin decolonization to reduce rates of bacteremia in patients undergoing extracorporeal membrane oxygenation |
| title_fullStr | Use of standardized nasal and skin decolonization to reduce rates of bacteremia in patients undergoing extracorporeal membrane oxygenation |
| title_full_unstemmed | Use of standardized nasal and skin decolonization to reduce rates of bacteremia in patients undergoing extracorporeal membrane oxygenation |
| title_short | Use of standardized nasal and skin decolonization to reduce rates of bacteremia in patients undergoing extracorporeal membrane oxygenation |
| title_sort | use of standardized nasal and skin decolonization to reduce rates of bacteremia in patients undergoing extracorporeal membrane oxygenation |
| url | https://www.cambridge.org/core/product/identifier/S2732494X25000099/type/journal_article |
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