Comparison of Two Protocols to Prevent the Acquisition of Methicillin-Resistant Staphylococcus Aureus.

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00151606
Recruitment Status : Completed
First Posted : September 9, 2005
Last Update Posted : January 10, 2006
Ministry of Health, France
Information provided by:
Rennes University Hospital

Brief Summary:
Nosocomial infections is a major problem in intensive care units due to both growing incidence and pathogens implicated which become increasingly resistant to antibiotics. According to the Center for Disease Control (USA), Staphylococcus aureus is responsible for approximately 10% of cases. In Europe, 79% of the S.aureus strains are resistant to methicillin, a routinely used antibiotic. Recommendations for the prevention of transmission of these resistant bacteria are rarely based on controlled trials. Therefore the aim of our study is to evaluate two protocols to prevent the acquisition of methicillin-resistant S. Aureus in intensive care units: either a reinforced isolation precautions protocol or a standard precautions protocol.

Condition or disease Intervention/treatment Phase
Nosocomial Infections MRSA Colonization Procedure: Reinforced isolation + Muciprocine Not Applicable

Detailed Description:

Recommendations for the prevention of transmission of resistant bacteria in intensive care units (ICU) are rarely based on controlled trials. For this reason, we compared a reinforced isolation precautions protocol (RIPP) with a standard precautions protocol (SPP) for the acquisition of methicillin-resistant Staphylococcus aureus (MRSA) in 2 intensive care units.

Evaluation: the risk for MRSA carriage was defined on admission if 1 of 3 criteria were met: hospitalization in the past year, transfer with prior length of stay ≥2 days, prior history of MRSA in the 5 past years.

Intervention: Randomization 1/1 of a total of 500 patients to either protocol; MRSA screening was performed at the sites of carriage and colonization at inclusion, every week and at ICU discharge in all patients; the results were given to the clinicians only for the patients of the RIPP group.

Protocols: the SPP was consistent with the CDC recommendations and included transmission-based isolation precautions to patients with clinical samples involving resistant bacteria (including MRSA) or highly transmissible organisms. The RIPP included the extension of isolation precautions (1) to patients at risk for MRSA on admission until screening results proved negative and (2) to MRSA-positive patients on screening or clinical samples until further negative samples, in whom nasal mupirocin decontamination was added. Compliance with the recommendations of each protocol was controlled by an audit.

The efficacy is assessed on the proportion of patients who acquired MRSA at any site.

Study Type : Interventional  (Clinical Trial)
Enrollment : 500 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Prevention
Official Title: Evaluation of Two Protocols to Prevent the Acquisition of Methicillin-Resistant Staphylococcus Aureus in Intensive Care Units.
Study Start Date : December 2002
Study Completion Date : February 2004

Resource links provided by the National Library of Medicine

MedlinePlus related topics: MRSA
U.S. FDA Resources

Primary Outcome Measures :
  1. Proportion of patients who acquired MRSA at any site during their hospitalization in intensive care unit.

Secondary Outcome Measures :
  1. - Rate of nosocomial MRSA infections
  2. - Rate of nosocomial infections due to other pathogens
  3. - Rate of nosocomial infections according to the site
  4. - Death rate at the exit of intensive care unit
  5. - Additional cost due to reinforced isolation protocol
  6. - Antistaphylococcal antibiotics use in both protocols
  7. - Number of days of antibiotherapy
  8. - Time and cause of septic isolation

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Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Adults over 18 years
  • Expected length of stay > 48h in intensive care unit
  • Informed written consent

Exclusion Criteria:

  • Cerebral death
  • Care limitation
  • Neutropenia
  • Documented MRSA on admission
  • Patients receiving antistaphylococcal topical antibiotics on admission

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To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00151606

Service de Maladies Infectieuses et Réanimation Médicale - Hôpital Pontchaillou
Rennes, France, 35033
Service de Réanimation Médicale - Hôpital Bretonneau
Tours, France, 37000
Sponsors and Collaborators
Rennes University Hospital
Ministry of Health, France
Principal Investigator: Christophe Camus, MD Rennes University Hospital
Study Chair: Eric Bellissant, MD, PhD Rennes University Hospital

Publications of Results:
Other Publications:
Publications automatically indexed to this study by Identifier (NCT Number): Identifier: NCT00151606     History of Changes
Other Study ID Numbers: AFSSAPS 020551
First Posted: September 9, 2005    Key Record Dates
Last Update Posted: January 10, 2006
Last Verified: January 2006

Keywords provided by Rennes University Hospital:
Infection prevention
Resistant bacteria
MRSA colonization

Additional relevant MeSH terms:
Staphylococcal Infections
Cross Infection
Gram-Positive Bacterial Infections
Bacterial Infections
Iatrogenic Disease
Disease Attributes
Pathologic Processes
Anti-Bacterial Agents
Anti-Infective Agents