Chlorhexidine versus routine bathing to prevent multidrug-resistant organisms and all-cause bloodstream infections in general medical and surgical units (ABATE Infection trial): a cluster-randomised trial

There were 189,081 patients in the baseline period and 339,902 patients (156,889 patients in the routine care group and 183,013 patients in the decolonization group) in the intervention period across 194 non-critical-care units in 53 hospitals. For the primary outcome of unit-attributable MRSA-positive or VRE-positive clinical cultures, the HR for the intervention period versus the baseline period was 0.79 (0.73-0.87) in the decolonization group versus 0.87 (95% CI 0.79-0.95) in the routine care group. No difference was seen in the relative HRs (p=0.17). There were 25 (<1%) adverse events, all involving chlorhexidine, among 183,013 patients in units assigned to chlorhexidine, and none were reported for mupirocin. Decolonization with universal chlorhexidine bathing and targeted mupirocin for MRSA carriers did not significantly reduce MDROs in non-critical-care patients.

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, Lankiewicz 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 infections in general medical and surgical units (ABATE Infection trial): a cluster-randomised trial. Lancet. 2019 Mar 23;393:1205-1215. doi:10.1016/S0140-6736(18)32593-5