美国加州大学洛杉矶分校医学中心Loren G. Miller团队研究了疗养院居民去定植以预防感染和住院的效果。该研究成果发表在2023年10月10日出版的《新英格兰医学杂志》上。

疗养院居民感染、住院和多药耐药生物定植的风险很高。

研究组进行了一项关于普遍去定植的集群随机试验，并与疗养院的常规护理沐浴进行了比较。该试验包括一个18个月的基线期和一个18个月的干预期。去定植需要在所有常规沐浴和淋浴中使用氯己定，并在入院后的前5天每天鼻用两次聚维酮碘，之后每隔一周每天两次，持续5天。主要结局是因感染转院。次要结局是全因转院。使用广义线性混合模型对各试验组的干预期与基线期进行比较，并对每个结果进行意向治疗差异分析。

数据来自28家疗养院，共有28956名居民。在常规护理组转院的患者中，62.2%（各机构的平均值）是由于基线期间的感染，62.6%是由于干预期间的感染（风险比为1.00）。去定植组的相应值分别为62.9%和52.2%（风险比为0.83），与常规护理组相比，风险比差异为16.6%。

在常规护理组从疗养院出院的患者中，在基线期间，全因转院的患者占36.6%，在干预期间占39.2%（风险比为1.08）。去定植组的相应值分别为35.5%和32.4%（风险比为0.92），与常规护理组相比，风险比差异为14.6%。

研究结果表明，在疗养院，氯己定和鼻碘伏的普遍去定植与常规护理相比显著降低了因感染而转院的风险。

附：英文原文

Title: Decolonization in Nursing Homes to Prevent Infection and Hospitalization

Author: Loren G. Miller, James A. McKinnell, Raveena D. Singh, Gabrielle M. Gussin, Ken Kleinman, Raheeb Saavedra, Job Mendez, Tabitha D. Catuna, James Felix, Justin Chang, Lauren Heim, Ryan Franco, Thomas Tjoa, Nimalie D. Stone, Karl Steinberg, Nancy Beecham, Jocelyn Montgomery, DeAnn Walters, Steven Park, Steven Tam, Shruti K. Gohil, Philip A. Robinson, Marlene Estevez, Brian Lewis, Julie A. Shimabukuro, Gregory Tchakalian, Aaron Miner, Crystal Torres, Kaye D. Evans, Cassiana E. Bittencourt, Jiayi He, Eunjung Lee, Christine Nedelcu, Julia Lu, Shalini Agrawal, S. Gwynn Sturdevant, Ellena Peterson, Susan S. Huang

Issue&Volume: 2023-10-10

Abstract:

Background

Nursing home residents are at high risk for infection, hospitalization, and colonization with multidrug-resistant organisms.

Methods

We performed a cluster-randomized trial of universal decolonization as compared with routine-care bathing in nursing homes. The trial included an 18-month baseline period and an 18-month intervention period. Decolonization entailed the use of chlorhexidine for all routine bathing and showering and administration of nasal povidone–iodine twice daily for the first 5 days after admission and then twice daily for 5 days every other week. The primary outcome was transfer to a hospital due to infection. The secondary outcome was transfer to a hospital for any reason. An intention-to-treat (as-assigned) difference-in-differences analysis was performed for each outcome with the use of generalized linear mixed models to compare the intervention period with the baseline period across trial groups.

Results

Data were obtained from 28 nursing homes with a total of 28,956 residents. Among the transfers to a hospital in the routine-care group, 62.2% (the mean across facilities) were due to infection during the baseline period and 62.6% were due to infection during the intervention period (risk ratio, 1.00; 95% confidence interval [CI], 0.96 to 1.04). The corresponding values in the decolonization group were 62.9% and 52.2% (risk ratio, 0.83; 95% CI, 0.79 to 0.88), for a difference in risk ratio, as compared with routine care, of 16.6% (95% CI, 11.0 to 21.8; P<0.001). Among the discharges from the nursing home in the routine-care group, transfer to a hospital for any reason accounted for 36.6% during the baseline period and for 39.2% during the intervention period (risk ratio, 1.08; 95% CI, 1.04 to 1.12). The corresponding values in the decolonization group were 35.5% and 32.4% (risk ratio, 0.92; 95% CI, 0.88 to 0.96), for a difference in risk ratio, as compared with routine care, of 14.6% (95% CI, 9.7 to 19.2). The number needed to treat was 9.7 to prevent one infection-related hospitalization and 8.9 to prevent one hospitalization for any reason.

Conclusions

In nursing homes, universal decolonization with chlorhexidine and nasal iodophor led to a significantly lower risk of transfer to a hospital due to infection than routine care.

DOI: 10.1056/NEJMoa2215254

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2215254