P-1918. Reduction in Antibiotic Use Due to Universal Decolonization in Nursing Homes (Secondary Analysis of the Protect Trial)
Abstract
Abstract Background The Protect trial (NEJM 2023 PMID: 37815935) was a cluster randomized trial of 28 nursing homes that found that universal decolonization— CHG bathing and nasal iodophor— reduced infection-related hospitalizations per 1000 resident days by 31%. We evaluated whether this intervention also reduced antibiotic use. Methods We conducted a secondary analysis of the Protect trial to evaluate antibiotics given to residents in nursing homes assigned to routine care versus decolonization. Outcome was defined as the number of days of antibiotic administration during the 7 days reported for each Minimum Data Set (MDS) assessment (admission, quarterly, discharge). We conducted a difference-in-differences logistic regression analysis using generalized linear mixed models to account for clustering within facility using an interaction term between study arm and time period. Results Comparing the intervention to baseline period, decolonization nursing homes had a 57.5% lower odds of antibiotic prescription (OR=0.425, 95% CI: 0.403-0.448) compared to a 32.4% lower odds in routine care nursing homes (OR=0.676, 95% CI: 0.648-0.705), resulting in a 39.0% greater relative reduction (relative OR=0.610, 95% CI 0.585-0.635; p< 0.0001) after adjusting for age, gender, race, ethnicity, insurance, and coexisting conditions. Unadjusted analyses showed similar results, supporting the robustness of the findings. Predicted probabilities showed antibiotic use decreased from 6.3% to 2.8%…
How strong is the evidence?
Evidence Hub reads this as a secondary / pooled analysis, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence.
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