Results of ABATE infection trial published

BOSTON, MA – Daily bathing with an antiseptic soap, plus nasal ointment for patients with prior antibiotic resistant bacteria, reduced hospital acquired infections among patients with central venous catheters and other devices that pierce the skin, according to results of the ABATE Infection Trial. The trial was a 53 hospital randomized trial involving approximately 340,000 patients led by researchers from the Harvard Pilgrim Health Care Institute, the University of California Irvine, Rush University and HCA Healthcare (HCA). The study, “Chlorhexidine versus Routine Bathing to Prevent Multi Drug-Resistant Organisms and All-Cause Bloodstream Infection in General Medical and Surgical Units: The ABATE Infection Cluster Randomized Trial,” was published March 5 in The Lancet, Online.

The ABATE Infection Trial evaluated whether daily bathing with an antiseptic soap for all patients, plus nasal mupirocin antibiotic ointment in the nose of patients with a history of methicillin resistant Staphylococcus aureus (MRSA), reduced hospital infections and antibiotic-resistant bacteria. The investigators found that patients with devices, such as central venous catheters, midline catheters, and lumbar drains, benefitted from the intervention, while there was no significant benefit in the entire population of non-ICU patients. These patients with devices experienced a 30% decrease in bloodstream infections and a nearly 40% decrease in antibiotic resistant organisms, specifically MRSA and vancomycin-resistant enterococcus. Patients with these devices are at higher risk for infection and that may explain why they benefitted. Overall, patients with devices account for over half of all bloodstream infections that occur in the hospital setting.

“Several ICU trials have shown striking reductions in infections and antibiotic resistant bacteria using daily chlorhexidine bathing and nasal decolonization with mupirocin. We wanted to know if patients outside the ICU could benefit from a similar decolonization strategy,” said lead author Susan S. Huang, M.D., MPH., Professor of Medicine, Division of Infectious Diseases, University of California, Irvine School of Medicine.

“Until additional data becomes available, we believe it will be worthwhile to adopt this decolonization strategy as best practice in non-ICU patients with devices like these to reduce bloodstream infection and antibiotic resistant organisms,” said senior author Richard Platt, M.D, M.Sc., Professor and Chair of the Department of Population Medicine at the Harvard Pilgrim Health Care Institute and Harvard Medical School. “Following the ICU trials, many hospitals adopted antiseptic bathing for patients with devices outside of the ICU ahead of scientific evidence to do so. This trial provides support for that strategy, while also pointing to the need for additional information.”

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The Harvard Pilgrim Health Care Institute’s Department of Population Medicine is a unique collaboration between Harvard Pilgrim Health Care and Harvard Medical School. Created in 1992, it is the only appointing medical school department in the United States based in a health plan. The Institute focuses on improving health care delivery and population health through innovative research and teaching. For more information, visit http://www.populationmedicine.org.

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