Targeted versus Universal

Decolonization to Prevent ICU Infection

Huang SS, Septimus E, Kleinman K, Moody J, Hickok J, Avery TR, et al.
N Engl J Med 368;24
PENDAHULUAN
Dekolonisasi : tindakan mengurangi kolonisasi
bakteri
chlorhexidine efektif untuk mengurangi
kolonisasi MRSA
Methicillin-resistant Staphylococcus aureus
(MRSA) target reduksi utama
Health care-associated infection dapat
dicegah


KAPAN
DIPERIKSA?
PENDAHULAN
Penelitian ini membandingkan antara
dekolonisasi universal dengan dekolonisasi
target, serta membandingkan keduanya
dengan skrining dan contact precautions
MRSA tanpa dekolonisasi.
METODE
Pragmatic cluster randomized trial,
comparative effectiveness trial
Periode I: baseline
Periode II: phase in
Periode III: intervensi
METODE
Kriteria inklusi

Bersedia mengikuti randomisasi untuk penelitian
Hanya < 30% pasien ICU yang mendapatkan
mupirocin maupun chlorhexidine pada periode
baseline
Bersedia untuk melakukan program pencegahan
infeksi pada periode baseline
Bersedia untuk menolak program pencegahan
infeksi yang bertentangan dengan peneitian
Rumah Sakit 3 kelompok
Kelompok I: skrining dan isolasi MRSA
Kelompok 2: dekolonisasi target (skrining,
isolasi MRSA, dan dekolonisasi pada carrier
MRSA)
Kelompok 3: dekolonisasi universal

METODE
Dekolonisasi pemberian salep mupirocin
2% intranasal selama 5 hari, dan mandi
menggunakan chlorhexidine setiap hari
selama perawatan di ICU.
Primary outcome: kultur MRSA yang positif
Secondary outcomes: angka kejadian blood
stream infection yang disebabkan MRSA atau
bakteri patogen lain

KESIMPULAN
Dekolonisasi universal lebih efektif
dibandingkan dekolonisasi target maupun
skrining dan isolasi dalam menurunkan angka
infeksi MRSA dan infeksi yang disebabkan
bakteri patogen lain.
KELEMAHAN
Belum dilakukan penelitian tentang resistensi
terhadap chlorhexidine maupun mupirocin
Tidak dilakukan penelitian tentang infeksi
selain blood stream infection
CRITICAL APPRAISAL
1. Was the assignment of patients to
treatments randomised?
Yes.
Rumah Sakit secara acak dibagi ke
dalam 3 kelompok
2. Were the groups similar at the start of
the trial?
Yes
Karakteristik sampel setara
3. Aside from the allocated treatment,
were groups treated equally?
Yes
Tidak ada perbedaan perlakuan selain
dari allocated treatment
4. Were all patients who entered the trial
accounted for? and were they
analysed in the groups to which they
were randomised?
Yes
5. Were measures objective or were the
patients and clinicians kept blind to
which treatment was being received?
No
Is this evidence about this study valid?
VALID
CRITICAL APPRAISAL
IMPORTANT
How precise was the
estimate of the treatment
effect?
Confident interval 95%
How large was the treatment
effect?

-RR: < 0.6
-1 infection was prevented per 54
patients who went decolonization

CRITICAL APPRAISAL
1. Is my patient so different to those
in the study that the results cannot
apply?
No.
2. Is the treatment feasible in my
setting?
Yes
3. Will the potential benefits of
treatment outweigh the potential
harms of treatment for my
patient?
No
Can we apply this valid, important evidence about this
study to our patient?
APPLICABLE