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

Clin Infect Dis. 2021 Feb 1;72(3):431-437. doi: 10.1093/cid/ciaa071.


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.

Keywords: antibiotic resistance; barrier precautions; contact precautions.

Publication types

  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Cross Infection* / drug therapy
  • Cross Infection* / prevention & control
  • Gloves, Protective
  • Gram-Negative Bacteria
  • Humans
  • Intensive Care Units
  • Methicillin-Resistant Staphylococcus aureus*


  • Anti-Bacterial Agents

Associated data