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Edgar Allan Poe/Sullivan's Island Library
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Phone: (843) 883-3914
West Ashley Library
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Wando Mount Pleasant Library
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Village Library
9 a.m. – 6 p.m.
Phone: (843) 884-9741
St. Paul's/Hollywood Library
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Hurd/St. Andrews Library
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Phone: (843) 805-6930
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Decontamination Strategies and Bloodstream Infections With Antibiotic-Resistant Microorganisms in Ventilated Patients: A Randomized Clinical Trial.
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- Author(s): Wittekamp, Bastiaan H.; Plantinga, Nienke L.; Cooper, Ben S.; Lopez-Contreras, Joaquin; Coll, Pere; Mancebo, Jordi; Wise, Matt P.; Morgan, Matt P. G.; Depuydt, Pieter; Boelens, Jerina; Dugernier, Thierry; Verbelen, Valérie; Jorens, Philippe G.; Verbrugghe, Walter; Malhotra-Kumar, Surbhi; Damas, Pierre; Meex, Cécile; Leleu, Kris; van den Abeele, Anne-Marie; Gomes Pimenta de Matos, Ana Filipa
- Source:
JAMA: Journal of the American Medical Association; 11/27/2018, Vol. 320 Issue 20, p2087-2098, 12p- Subject Terms:
BIOLOGICAL decontamination; ALIMENTARY canal; ARTIFICIAL respiration; INTENSIVE care units; CHLORHEXIDINE; INFECTION; ANTI-infective agents; BACTEREMIA prevention; GRAM-negative bacterial diseases; CROSS infection prevention; GUT microbiome; MOUTHWASHES; COMPARATIVE studies; DRUG resistance in microorganisms; RESEARCH methodology; MEDICAL cooperation; RESEARCH; STERILIZATION (Disinfection); EVALUATION research; RANDOMIZED controlled trials; HOSPITAL mortality; OROPHARYNX; PREVENTION; THERAPEUTICS - Source:
- Additional Information
- Abstract:
Importance: The effects of chlorhexidine (CHX) mouthwash, selective oropharyngeal decontamination (SOD), and selective digestive tract decontamination (SDD) on patient outcomes in ICUs with moderate to high levels of antibiotic resistance are unknown.Objective: To determine associations between CHX 2%, SOD, and SDD and the occurrence of ICU-acquired bloodstream infections with multidrug-resistant gram-negative bacteria (MDRGNB) and 28-day mortality in ICUs with moderate to high levels of antibiotic resistance.Design, Setting, and Participants: Randomized trial conducted from December 1, 2013, to May 31, 2017, in 13 European ICUs where at least 5% of bloodstream infections are caused by extended-spectrum β-lactamase-producing Enterobacteriaceae. Patients with anticipated mechanical ventilation of more than 24 hours were eligible. The final date of follow-up was September 20, 2017.Interventions: Standard care was daily CHX 2% body washings and a hand hygiene improvement program. Following a baseline period from 6 to 14 months, each ICU was assigned in random order to 3 separate 6-month intervention periods with either CHX 2% mouthwash, SOD (mouthpaste with colistin, tobramycin, and nystatin), or SDD (the same mouthpaste and gastrointestinal suspension with the same antibiotics), all applied 4 times daily.Main Outcomes and Measures: The occurrence of ICU-acquired bloodstream infection with MDRGNB (primary outcome) and 28-day mortality (secondary outcome) during each intervention period compared with the baseline period.Results: A total of 8665 patients (median age, 64.1 years; 5561 men [64.2%]) were included in the study (2251, 2108, 2224, and 2082 in the baseline, CHX, SOD, and SDD periods, respectively). ICU-acquired bloodstream infection with MDRGNB occurred among 144 patients (154 episodes) in 2.1%, 1.8%, 1.5%, and 1.2% of included patients during the baseline, CHX, SOD, and SDD periods, respectively. Absolute risk reductions were 0.3% (95% CI, -0.6% to 1.1%), 0.6% (95% CI, -0.2% to 1.4%), and 0.8% (95% CI, 0.1% to 1.6%) for CHX, SOD, and SDD, respectively, compared with baseline. Adjusted hazard ratios were 1.13 (95% CI, 0.68-1.88), 0.89 (95% CI, 0.55-1.45), and 0.70 (95% CI, 0.43-1.14) during the CHX, SOD, and SDD periods, respectively, vs baseline. Crude mortality risks on day 28 were 31.9%, 32.9%, 32.4%, and 34.1% during the baseline, CHX, SOD, and SDD periods, respectively. Adjusted odds ratios for 28-day mortality were 1.07 (95% CI, 0.86-1.32), 1.05 (95% CI, 0.85-1.29), and 1.03 (95% CI, 0.80-1.32) for CHX, SOD, and SDD, respectively, vs baseline.Conclusions and Relevance: Among patients receiving mechanical ventilation in ICUs with moderate to high antibiotic resistance prevalence, use of CHX mouthwash, SOD, or SDD was not associated with reductions in ICU-acquired bloodstream infections caused by MDRGNB compared with standard care.Trial Registration: ClinicalTrials.gov Identifier: NCT02208154. [ABSTRACT FROM AUTHOR] - Abstract: Copyright of JAMA: Journal of the American Medical Association is the property of American Medical Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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