scholarly journals The effects of topical antibiotics on eradication and acquisition of third-generation cephalosporin and carbapenem-resistant Gram-negative bacteria in ICU patients; a post hoc analysis from a multicentre cluster-randomized trial

2020 ◽  
Vol 26 (4) ◽  
pp. 485-491 ◽  
Author(s):  
N.L. Plantinga ◽  
B.H.J. Wittekamp ◽  
C. Brun-Buisson ◽  
M.J.M. Bonten ◽  
B.S. Cooper ◽  
...  
Keyword(s):  
Cluster Randomized Trial ◽  
Generation Cephalosporin ◽  
Gram Negative Bacteria ◽  
Icu Patients ◽  
Gram Negative ◽  
Topical Antibiotics ◽  
Post Hoc Analysis ◽  
Carbapenem Resistant ◽  
Cluster Randomized ◽  
Post Hoc

scholarly journals 515. Acquisition of Antibiotic-Resistant Gram-Negative Bacteria in the Benefits of Universal Glove and Gown (BUGG) Cluster Randomized Trial

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S248-S249
Author(s):  
Anthony Harris ◽  
Daniel Morgan ◽  
Lisa Harris ◽  
Laurence S Magder ◽  
Lyndsay M O’Hara ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Cluster Randomized Trial ◽  
Effect Sizes ◽  
Gram Negative Bacteria ◽  
Patient Contact ◽  
Antibiotic Resistant ◽  
Gram Negative ◽  
Carbapenem Resistant ◽  
Secondary Outcomes ◽  
Cluster Randomized

Abstract Background The Benefits of Universal Gloves and Gowns (BUGG) randomized trial found a decrease in MRSA acquisition, no effect on VRE acquisition and no increase in adverse events with the intervention of wearing gloves and gowns for all patient contact in the intensive care unit (ICU). The objective of the study was to assess whether wearing gloves and gowns for all patient contact in the ICU decreases the acquisition of antibiotic-resistant Gram-negative bacteria. Methods Design: Secondary study of the BUGG cluster-randomized trial. Participants: 20 medical and surgical ICUs in 20 US hospitals. Intervention: Healthcare workers were required to wear gloves and gowns when entering any patient room compared with standard care. Main outcomes and measures: The primary composite outcome was acquisition of any antibiotic-resistant Gram-negative bacteria based on surveillance cultures collected on admission and discharge. Secondary outcomes were acquisition of carbapenem-resistant Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacteriaceae, or ESBL-producing Enterobacteriaceae. Results For the primary outcome, the intervention had a RR of 0.90 (95% CI 0.71 to 1.12, P = 0.34). Effects on the secondary outcomes were: carbapenem-resistant Enterobacteriaceae [RR 0.86 (95% CI, 0.60 to 1.24), P = 0.43], carbapenem-resistant Acinetobacter [RR 0.81 (95% CI, 0.52 to 1.27) P = 0.36], carbapenem-resistant Pseudomonas [RR 0.88 (95% CI, 0.55 to 1.42) P = 0.62], ESBL producing bacteria [RR 0.94, (95% CI, 0.71 to 1.24) P = 0.67]. Conclusion The association of universal glove and gown use in the ICU with acquisition of antibiotic-resistant Gram-negative bacteria was inconclusive. The observed rate ratios for all five outcomes suggest that the intervention was protective, however, none were statistically significant. The study was likely underpowered to detect statistical significance for the effect sizes found. Individual hospitals should consider implementing the intervention based on the importance of these organisms at their hospital, effect sizes, confidence intervals, and cost. Disclosures All authors: No reported disclosures.

scholarly journals Acquisition of Antibiotic-Resistant Gram-negative Bacteria in the Benefits of Universal Glove and Gown (BUGG) Cluster Randomized Trial

2020 ◽  
Author(s):  
Anthony D Harris ◽  
Daniel J Morgan ◽  
Lisa Pineles ◽  
Larry Magder ◽  
Lyndsay M O’Hara ◽  
...  
Keyword(s):  
Intensive Care ◽  
Randomized Trial ◽  
Primary Outcome ◽  
Secondary Analysis ◽  
Cluster Randomized Trial ◽  
Gram Negative Bacteria ◽  
Antibiotic Resistant ◽  
Gram Negative ◽  
Carbapenem Resistant ◽  
Cluster Randomized

Abstract Background The Benefits of Universal Glove and Gown (BUGG) cluster randomized trial found varying effects on methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus and no increase in adverse events. The aim of this study was to assess whether the intervention decreases the acquisition of antibiotic-resistant gram-negative bacteria. Methods This was a secondary analysis of a randomized trial in 20 hospital intensive care units. The intervention consisted of healthcare workers wearing gloves and gowns when entering any patient room compared to standard care. The primary composite outcome was acquisition of any antibiotic-resistant gram-negative bacteria based on surveillance cultures. Results A total of 40 492 admission and discharge perianal swabs from 20 246 individual patient admissions were included in the primary outcome. For the primary outcome of acquisition of any antibiotic-resistant gram-negative bacteria, the intervention had a rate ratio (RR) of 0.90 (95% confidence interval [CI], .71–1.12; P = .34). Effects on the secondary outcomes of individual bacteria acquisition were as follows: carbapenem-resistant Enterobacteriaceae (RR, 0.86 [95% CI, .60–1.24; P = .43), carbapenem-resistant Acinetobacter (RR, 0.81 [95% CI, .52–1.27; P = .36), carbapenem-resistant Pseudomonas (RR, 0.88 [95% CI, .55–1.42]; P = .62), and extended-spectrum β-lactamase–producing bacteria (RR, 0.94 [95% CI, .71–1.24]; P = .67). Conclusions Universal glove and gown use in the intensive care unit was associated with a non–statistically significant decrease in acquisition of antibiotic-resistant gram-negative bacteria. Individual hospitals should consider the intervention based on the importance of these organisms at their hospital, effect sizes, CIs, and cost of instituting the intervention. Clinical Trials Registration NCT01318213.

scholarly journals Cardiac events after macrolides or fluoroquinolones in patients hospitalized for community-acquired pneumonia: post-hoc analysis of a cluster-randomized trial

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Douwe F. Postma ◽  
Cristian Spitoni ◽  
Cornelis H. van Werkhoven ◽  
Leontine J. R. van Elden ◽  
Jan Jelrik Oosterheert ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Cluster Randomized Trial ◽  
Community Acquired Pneumonia ◽  
Cardiac Events ◽  
Post Hoc Analysis ◽  
Cluster Randomized ◽  
Post Hoc

scholarly journals Cardiac events after macrolides or fluoroquinolones in patients hospitalized for community-acquired pneumonia: post-hoc analysis of a cluster-randomized trial

2017 ◽  
Author(s):  
D.F. Postma ◽  
C. Spitoni ◽  
C.H. van Werkhoven ◽  
L.J.R. van Elden ◽  
J.J. Oosterheert ◽  
...  
Keyword(s):  
Heart Failure ◽  
Myocardial Ischemia ◽  
Cardiac Event ◽  
Cluster Randomized Trial ◽  
Community Acquired Pneumonia ◽  
Cardiac Events ◽  
Post Hoc Analysis ◽  
Hazard Ratios ◽  
Cluster Randomized ◽  
Post Hoc

ABSTRACTBackgroundGuidelines recommend macrolides and fluoroquinolones in patients hospitalized with community-acquired pneumonia (CAP), but their use has been associated with cardiac events.ObjectiveTo quantify associations between macrolide and fluoroquinolone use and cardiac events in patients hospitalized with CAP in non-ICU wards.DesignPost-hoc analysis of a cluster-randomized trialSettingSix hospitals in the NetherlandsPatientsCAP patients admitted to non-ICU wards and without a cardiac event on admissionMeasurementsCause-specific hazard ratio’s (HR’s) were calculated for effects of time-dependent macrolide and fluoroquinolone exposure on cardiac events, defined as occurrence of new or worsening heart failure, arrhythmia, or myocardial ischemia during hospitalization.ResultsCardiac events occurred in 146 (6.9%) of 2,107 patients and included episodes of heart failure (n=101, 4.8%), arrhythmia (n=53, 2.5%), and myocardial ischemia (n=14, 0.7%). Cardiac events occurred in 11 of 207 (5.3%), 18 of 250 (7.2%), and 31 of 277 (11.2%) patients exposed to azithromycin, clarithromycin, and erythromycin for at least one day, respectively, and in 9 of 234 (3.8%), 5 of 194 (2.6%), and 23 of 566 (4.1%) patients exposed to ciprofloxacin, levofloxacin, and moxifloxacin, respectively. Hazard ratios for any cardiac event, adjusted for confounding, were 0.89 (95% confidence interval (CI) 0.48 to 1.67), 1.06 (95% CI 0.61 to 1.83) and 1.68 (95% CI 1.07 to 2.62) for azithromycin, clarithromycin, and erythromycin, respectively, and adjusted hazard ratios were 0.86 (95% CI 0.47 to 1.57), 0.42 (95% CI 0.18 to 0.96) and 0.62 (95% CI 0.39 to 0.99) for ciprofloxacin, levofloxacin, and moxifloxacin, respectively. Erythromycin was associated with an adjusted hazard ratio of 2.08 (95% CI 1.25 to 3.46) for heart failure.LimitationsPossibility of confounding by indication and observational biasConclusionsAmong patients with CAP hospitalized to non-ICU wards, erythromycin use was associated with a 68% increased risk of hospital-acquired cardiac events, mainly heart failure. Levofloxacin and moxifloxacin were associated with a lower risk of heart failure.RegistrationThe original trial was registered under ClinicalTrials.gov Identifier NCT01660204Funding SourceThe Netherlands Organization for Health Research and Development (ZONmw, Health care efficiency research, project id: 171202002).

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