Written by Mary Marschner
Spoon Feed
The ABATE trial subanalysis found targeted chlorhexidine bathing and nasal mupirocin for MRSA carriers with medical devices reduced bloodstream infections and multidrug-resistant organisms, proving cost-effective for most hospitals.
It makes cents to prevent bloodstream infections
Preventing bloodstream infections is so important for our patients (not to mention hospitals are penalized financially when they happen). This study looked at the costs of implementing different prevention strategies for both the payor and the hospital and makes an argument that it is cost effective to prevent these infections.
The REDUCE MRSA trial showed universal decolonization of patients in ICUs decreased blood stream infections, and the ABATE trial showed that chlorhexidine bathing, with targeted mupirocin for MRSA carriers, could reduce bloodstream infections and antibiotic resistant bacteria in non-ICU, hospitalized with medical devices. It’s important to note that they did not find universal decolonization changed bacteremia outcomes overall; it was just in the subgroup analysis of the patients with medical devices. Given the number of PICC line vs. midline articles I’ve read, all aimed at choosing the right device to lower the risk of infection, articles supporting other prevention strategies are somewhat refreshing.
This study conducted a cost-effectiveness analysis comparing universal decolonization (UD) and targeted decolonization (TD) strategies to standard care (SOC) in non-ICU hospitalized patients. Utilizing a decision-analytic model based on the ABATE Infection trial data, they found that TD, involving chlorhexidine bathing and nasal mupirocin for patients with medical devices, was more cost-effective than UD or SOC. TD reduced hospital-onset bacteremia and fungemia rates and was associated with lower costs, particularly when adherence exceeded 75%.
How does this change my practice?
This study effectively models cost-benefits, advocating hospitals consider targeted infection prevention strategies. Limitations include underestimated adherence, unaccounted operational costs, variable payor willingness, and unclear timelines for bacterial resistance emergence. It underscores the importance of clinician involvement in institutional decisions and reviewing preventive bloodstream infection strategies to reduce infections and cost.
Source
Universal vs Targeted Chlorhexidine Bathing and Nasal Decolonization in Hospitalized Patients. JAMA Netw Open. 2025 Mar 3;8(3):e250341. doi: 10.1001/jamanetworkopen.2025.0341. PMID: 40063027
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