Nevin Manimala

JAMA Health Forum. 2026 Jul 2;7(7):e262207. doi: 10.1001/jamahealthforum.2026.2207.

ABSTRACT

IMPORTANCE: Supply-side challenges combined with high costs and limited insurance coverage led to a robust market for compounded glucagon-like peptide-1 receptor agonists (GLP-1 RAs). However, assessment of this market since the end of the semaglutide and tirzepatide shortages is needed.

OBJECTIVE: To characterize available compounded GLP-1 RA products, describe aspects of patient care and monitoring, and identify source pharmacies of available compounded products.

DESIGN, SETTING, AND PARTICIPANTS: From August to October 2025, a cross-sectional secret shopper study was conducted of brick-and-mortar weight-loss clinics and medical spas advertising GLP-1 RAs for weight loss and offering compounded GLP-1 RAs. These businesses were identified in January 2025 using a web mapping application to perform location-based searches that were supplemented with a review of business websites and publicly available data regarding compounding facilities. The businesses were located in 2 states (West Virginia and Oklahoma) with potentially high demand for compounded GLP-1 RAs that were purposively selected based on obesity rate and insurance mix.

MAIN OUTCOMES AND MEASURES: Compounded GLP-1 RAs offered by weight-loss clinics and medical spas; aspects of patient care and monitoring; and characteristics of compounding suppliers, including facility type, licensing status, objectionable conditions noted by investigators, and disciplinary actions.

RESULTS: A total of 75 weight-loss clinics and medical spas offering compounded GLP-1 RAs were identified and included in the analysis. Of these businesses, 7 (9.3%) reported offering oral compounded GLP-1 RA formulations and 42 (56.0%) reported offering compounded GLP-1 RA products combined with B vitamins. Twenty-three compounding facilities were identified as suppliers, 4 (of 21; 19.0%) of which were not licensed to perform sterile compounding. Since 2023, 1 facility (4.3%) had received multiple US Food and Drug Administration warning letters and 3 of 22 (13.6%) had been subject to state-level disciplinary action.

CONCLUSIONS AND RELEVANCE: Findings of this study show that, after the end of the semaglutide and tirzepatide shortages, compounding facilities have continued to manufacture GLP-1 RAs with added ingredients. Compounded GLP-1 RA sourcing is diverse but includes facilities without licenses to perform sterile compounding or that have been subject to recent disciplinary action, posing clinical and regulatory challenges.

PMID:42467450 | DOI:10.1001/jamahealthforum.2026.2207

JAMA Health Forum. 2026 Jul 2;7(7):e262226. doi: 10.1001/jamahealthforum.2026.2226.

ABSTRACT

IMPORTANCE: Forty-three state Medicaid programs have bed-hold policies that reimburse nursing homes (NHs) to reserve a resident’s bed during a hospitalization or other temporary absence. Although bed-hold policies are intended to increase continuity of care, some evidence suggests they may incentivize NHs to hospitalize residents; however, these data are outdated, and the impact of bed-hold policies on resident outcomes remains understudied.

OBJECTIVE: To examine the association between Medicaid bed-hold policies and hospitalizations and emergency department (ED) visits among NH residents receiving long-term care.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study of long-stay NH residents in the US used claims data for a 20% national sample of Medicare fee-for-service beneficiaries from 2013 through 2018. Adjusted comparisons between states that did and did not adopt bed-hold policies were conducted using a staggered difference-in-differences design. Sensitivity analyses were conducted that (1) used composite outcomes combining death with hospitalization and ED visits, (2) restricted the sample to dually eligible residents, (3) excluded hospital-based NHs, (4) restricted the sample to NHs that were present for the entire study period, (5) restricted the sample to for-profit NHs, and (6) used alternate approaches to adjust standard errors. Data were analyzed between April and November 2025.

EXPOSURES: State adoption of a Medicaid bed-hold policy.

MAIN OUTCOMES AND MEASURES: Hospitalizations and ED visits in a given month were the 2 primary outcomes.

RESULTS: The sample included 219 719 long-stay NH residents (mean [SD] age, 80.2 [12.6] years; 67.2% female) in 22 states and the District of Columbia, of which 16 states adopted bed-hold policies. There were no significant changes in differences in resident and NH characteristics between those in states that did and did not adopt the policies from the pre- to the post-adoption period. Adjusted estimates did not show statistically significant changes in the likelihood of hospitalization (-0.1 percentage points [pp]; 95% CI, -0.3 to 0.1 pp; P = .41) or an ED visit (0.0 pp; 95% CI, -0.1 to 0.2 pp; P = .68) associated with adoption of bed-hold policies. Results of sensitivity analyses were consistent with the primary analyses.

CONCLUSIONS AND RELEVANCE: This cohort study found that states’ adoption of Medicaid bed-hold policies was not associated with hospitalizations or ED visits among long-stay NH residents, suggesting that the goal of bed-hold policies may not be undermined by increases in these events.

PMID:42467449 | DOI:10.1001/jamahealthforum.2026.2226

JAMA Netw Open. 2026 Jul 1;9(7):e2623302. doi: 10.1001/jamanetworkopen.2026.23302.

ABSTRACT

IMPORTANCE: Puberty blockers are an established, reversible intervention for central precocious puberty in children and gender dysphoria in adolescents. Despite broad clinical support, these treatments are currently politically contested.

OBJECTIVE: To characterize the mental health of transgender youths prescribed puberty blockers compared with cisgender peers who received these medications for treatment of precocious puberty and with transgender and cisgender youths who did not receive these medications.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used data from a US nationwide, multipayer claims database from January 2016 to January 2025. Youths aged 10 to 17 years were categorized into 4 cohorts based on gender modality (transgender or cisgender) and prescription of a puberty blocker (yes or no).

MAIN OUTCOMES AND MEASURES: Primary outcomes were International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnoses of mood disorders and suicidal thoughts and behaviors. Inverse probability-weighted generalized estimating equation models were fit to obtain adjusted odds ratios (aORs) and 95% CIs, adjusting for demographics, payer type, region, year, socioeconomic disadvantage, and policy environment indices. In demographics, female gender marker is used to indicate that an F (female) has been applied as a marker for the individual by some entity (eg, a medical professional or government body).

RESULTS: Among 231 783 youths in the analytical sample, 41 472 youths (17.89%) were transgender (median [IQR] age at baseline, 9.00 [7.00-11.00] years; 31 246 with female gender marker [75.34%]) and 190 311 youths (82.11%) were cisgender (median [IQR] age at baseline, 8.00 [6.00-10.00] years; 128 942 with female gender marker [67.75%]). Being transgender was associated with higher odds of mood disorder diagnosis (aOR, 4.42 [95% CI, 4.24-4.60]) and suicidal thoughts and behaviors (aOR, 12.21 [95% CI, 10.69-13.95]) compared with being cisgender. Being prescribed a puberty blocker was associated with higher odds of mood disorder diagnosis (aOR, 2.11 [95% CI, 2.02-2.19]) and suicidal thoughts and behaviors (aOR, 3.04 [95% CI, 2.65-3.49]) compared with no prescription. However, among transgender youths, prescription of a puberty blocker was associated with decreased adjusted odds of mood disorder diagnosis (aOR, 0.52 [95% CI, 0.45-0.60]) and suicidal thoughts and behaviors (aOR, 0.20 [95% CI, 0.14-0.29]).

CONCLUSIONS AND RELEVANCE: In this study, transgender youths overall had substantially higher rates of diagnosed mood disorder and suicidal thoughts and behaviors than their cisgender peers, highlighting the need for population-specific interventions. Prescription of a puberty blocker was associated with partial attenuation of this disparity, suggesting mental health benefits associated with this treatment for transgender youth.

PMID:42467435 | DOI:10.1001/jamanetworkopen.2026.23302

JAMA Netw Open. 2026 Jul 1;9(7):e2623617. doi: 10.1001/jamanetworkopen.2026.23617.

ABSTRACT

IMPORTANCE: Expanding access to naloxone is an essential strategy in addressing the overdose crisis in the US. In March 2023, the US Food and Drug Administration approved the first over-the-counter (OTC) naloxone nasal spray, representing a substantial shift in public health policy and pharmacy practice.

OBJECTIVE: To assess the same-day availability of naloxone without a prescription across US retail pharmacies and examine pharmacy and neighborhood factors associated with access following OTC approval.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used a secret shopper design to assess availability of naloxone in retail pharmacies in the US from January 15 to April 30, 2024. Participants included a stratified random sample of 1108 pharmacies from the 7 largest corporate pharmacy chains and an eighth stratum incorporating other retail pharmacies.

EXPOSURES: Pharmacy characteristics (chain size, type, and affiliation) and neighborhood sociodemographic indicators (racial and ethnic composition and area deprivation index).

MAIN OUTCOMES AND MEASURES: Same-day naloxone availability without a prescription, location of naloxone within the store, price, and alternative access suggestions.

RESULTS: Among the 1108 pharmacies contacted, an estimated 61.40% (95% CI, 57.34%-65.46%) of those with naloxone in stock reported it was available without a prescription. Naloxone was located at the pharmacy counter (estimate, 58.14% [95% CI, 53.59%-62.68%]), self-service aisles (estimate, 31.74% [95% CI, 27.59%-35.89%]), and front checkout areas (estimate, 8.99% [95% CI, 6.64%-11.34%]). The mean (SE) cost was $52.07 ($1.50) (95% CI, $49.12-$55.02). Among pharmacies without same-day naloxone (estimate, 38.60% [95% CI, 34.54%-42.66%]), respondents equally referred callers to another pharmacy or had no suggestions (estimate, 45.84% [95% CI, 37.77%-53.91%]), 4.46% (95% CI, 0.70%-8.21%) offered other suggestions (hospital, public service agencies, online service, or cannabis dispensary), 3.87% (95% CI, 0.48%-7.25%) suggested the public health department, and 0.06% (95% CI, 0.00%-0.17%) suggested syringe service programs. Pharmacies classified as food and/or mass merchandisers, independent, or medical affiliated had a lower odds ratio of offering same-day naloxone compared with corporate chains. In separate analyses, pharmacies located in areas with higher proportions of White residents were more likely to offer naloxone. Area deprivation index-defined neighborhood disadvantage, which does not include race in its calculation, was not associated with naloxone availability.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of pharmacies across the US, same-day naloxone availability and price remained uneven following OTC approval. As an initial national evaluation of same-day naloxone availability and price after OTC approval, the findings showed differences in implementation across pharmacy types and community demographic features. Although enactment of the OTC policy was necessary, its intended benefits were not realized equally in practice. Expanding pharmacist education and targeting support for independent and medical-affiliated pharmacies may help improve naloxone access, especially in rural and underserved areas.

PMID:42467434 | DOI:10.1001/jamanetworkopen.2026.23617

JAMA Netw Open. 2026 Jul 1;9(7):e2623740. doi: 10.1001/jamanetworkopen.2026.23740.

ABSTRACT

IMPORTANCE: Access to menopausal hormone therapy (MHT) in the US remains low. Understanding whether insurance type is associated with MHT underuse and racial disparities in menopausal care is critical for designing interventions that increase evidence-based and equitable menopause care.

OBJECTIVE: To examine whether Medicaid compared with private insurance is associated with lower MHT use among US women. A secondary objective explored the degree that payer type is associated with observed racial differences in MHT use.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used the 2013-2014, 2015-2016, and 2017-2020 cycles of the National Health and Nutrition Examination Survey (NHANES) to identify a survey-weighted analytic subset of eligible respondents of a population-based survey of the US civilian, noninstitutionalized population. The study included women aged 45 to 64 years with Medicaid or private insurance coverage who were eligible for MHT. Statistical analyses were performed between March 26, 2024, and December 2, 2025.

EXPOSURE: Insurance type.

MAIN OUTCOMES AND MEASURES: MHT use was the primary outcome. A secondary analysis assessed whether insurance status was associated with observed racial differences in MHT use. Associations were estimated using multivariable logistic regression.

RESULTS: The unweighted sample included 1666 National Health and Nutrition Examination Survey respondents (n = 22 275 545, weighted). Of the weighted final sample, 91.4% had private insurance, and 8.6% had Medicaid. Individuals insured by Medicaid were less likely than those with private insurance to report a history of MHT use (10.7% [95% CI, 6.9%-16.0%] vs 20.7% [95% CI, 18.1%-23.5%]). After adjustment, Medicaid-insured women had lower odds of MHT use than privately insured women (OR, 0.50 [95% CI, 0.28-0.87]). In a secondary analysis, Black participants showed lower odds of MHT than White participants (OR, 0.68 [95% CI, 0.45-0.95]), but this difference was attenuated once insurance status was included in the model (adjusted OR, 0.72 [95% CI, 0.50-1.04]).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of women at typical age for menopause, Medicaid coverage was associated with significantly lower MHT use, suggesting that insurance type may play a role in menopausal care disparities. Insurance status may also partially explain previously observed racial gaps in MHT use. These findings highlight the need for policy and clinical interventions to address insurance-related barriers and to promote equitable menopausal care.

PMID:42467433 | DOI:10.1001/jamanetworkopen.2026.23740

JAMA Netw Open. 2026 Jul 1;9(7):e2623860. doi: 10.1001/jamanetworkopen.2026.23860.

ABSTRACT

IMPORTANCE: Patients experiencing homelessness face particular barriers to hospital discharge, which may result in an alternate level of care (ALC) designation, a delayed discharge status describing patients occupying beds while not requiring the intensity of care provided in the hospital. Evidence quantifying disparities in ALC designation among patients with recent experience of homelessness relative to matched comparators is limited.

OBJECTIVE: To compare ALC rates among hospitalized patients with a recent experience of homelessness and matched patients from neighborhoods with the lowest level of material resources.

DESIGN, SETTING, AND PARTICIPANTS: This population-based matched cohort study was conducted in Ontario, Canada, among 51 377 hospital patients aged 16 years or older discharged from April 1, 2022, to March 31, 2024.

EXPOSURE: Patients with a recent experience of homelessness, classified using a validated definition using health administrative data. Unexposed patients from neighborhoods with the lowest level of material resources were matched 4:1 on age, sex, year and month of admission, health region, and Charlson Comorbidity Index.

MAIN OUTCOMES AND MEASURES: ALC designation and duration of ALC. Weighted standardized differences and negative binomial models were used to assess significance of disparities.

RESULTS: The study included 11 168 patients with a recent experience of homelessness (mean [SD] age, 48.5 [16.5] years; 7384 male [66.1%]) and 40 209 matched comparators (mean [SD] age, 49.6 [16.7] years; 25 561 male [63.6%]). Patients with a recent experience of homelessness had a more than 4-fold higher ALC designation rate (9.1% [1014 of 11 168] vs 2.0% [810 of 40 209]; weighted standardized difference = 0.32; rate ratio, 4.51 [95% CI, 4.11-4.95]). Health region-level variation was substantial, ranging from 2.39 (95% CI, 1.40-4.01) times higher in the Central West region to 7.88 (95% CI, 5.21-12.11) times higher in the Central region. Among patients designated an ALC, those with a recent experience of homelessness had a significantly longer ALC stay duration (incidence rate ratio, 1.22 [95% CI, 1.09-1.37]; difference of margins, 4.7 days [95% CI, 2.1-7.4 days]) after adjusting for key demographic and clinical factors.

CONCLUSIONS AND RELEVANCE: In this cohort study of hospitalized patients in Ontario, Canada, recent experience of homelessness was significantly associated with higher rates of ALC designation and increased lengths of ALC stay, reflecting structural barriers to accessing safe discharge locations and gaps in transitional and postacute care. Regional differences suggest that local capacity and supports may mitigate or exacerbate challenges. Interventions such as medical respite and supportive housing are critical to reducing delayed discharge among patients experiencing homelessness and promoting equitable health system performance.

PMID:42467431 | DOI:10.1001/jamanetworkopen.2026.23860

JAMA Netw Open. 2026 Jul 1;9(7):e2623880. doi: 10.1001/jamanetworkopen.2026.23880.

ABSTRACT

IMPORTANCE: Hormonal contraceptive use has important implications for both reproductive and general health. However, the patterns and trends of short-acting hormonal contraceptive use among US premenopausal females remain insufficiently characterized.

OBJECTIVE: To evaluate trends in and factors associated with prescribed short-acting hormonal contraceptive use among US premenopausal females.

DESIGN, SETTING, AND PARTICIPANTS: Serial, cross-sectional analyses were conducted using US nationally representative data from the National Health and Nutrition Examination Survey (NHANES), including 10 survey cycles between 1999 to 2000 and 2017 to 2020 (before the COVID-19 pandemic). Participants included noninstitutionalized premenopausal females aged 15 years to younger than 60 years without a history of breast cancer. Data were analyzed from January to November 2025.

EXPOSURES: NHANES cycle.

MAIN OUTCOMES AND MEASURES: The prevalence of prescribed short-acting hormonal contraceptive use was extracted from the prescription medication data collected during household interviews. Data primarily reflect oral contraceptives and were categorized as combined estrogen and progestin or progestin-only formulations.

RESULTS: Data on 15 531 premenopausal females (14.7% aged 15 to <20 years, 59.3% aged 20 to <40 years, 26.1% aged 40 to <60 years) were analyzed. Participants predominantly had an educational level higher than high school (59.8%), were privately insured (59.3%), and never smoked (58.7%). From 1999 to 2020, the prevalence of prescribed short-acting hormonal contraceptive use significantly increased from 5.2% (95% CI, 2.2%-11.5%) to 15.1% (95% CI, 10.7%-20.7%) for females aged 15 to younger than 20 years, was stable for females aged 20 to younger than 40 years (16.7% [95% CI, 13.2%-21.0%] to 13.3% [95% CI, 10.7%-16.4%]), and remained low among those aged 40 to younger than 60 years (3.8% [95% CI, 1.5%-9.3%] to 7.0% [95% CI, 4.0%-12.1%]). Compared with non-Hispanic White females, non-Hispanic Black and Hispanic females had lower prevalence of use and exhibited the greatest relative increases (prevalence ratio, 3.7 [95% CI, 1.0-13.7] among non-Hispanic Black females and 1.8 [95% CI, 0.9-3.7] among Hispanic females) from 1999 to 2020. Progestin-only formulations accounted for 0.4% (95% CI, 0.1%-2.5%) of the prescribed short-acting hormonal contraceptive prescriptions in 1999 to 2000 and remained low (5.2% [95% CI, 3.0%-8.9%)] in 2017-2020. The prevalence of short-acting hormonal contraceptive use varied by race and ethnicity in all age groups, by family income to poverty ratio, educational attainment, health insurance coverage, marital status, and weight status among females aged 20 to younger than 40 years and by family income to poverty ratio and smoking status among females aged 40 to younger than 60 years.

CONCLUSIONS AND RELEVANCE: In this serial cross-sectional study of US premenopausal females, prescribed short-acting hormonal contraceptive use increased among females aged 15 to younger than 20 years and among non-Hispanic Black and Hispanic females. Across all groups, the use of progestin-only formulations remained low over time.

PMID:42467430 | DOI:10.1001/jamanetworkopen.2026.23880

Womens Health (Lond). 2026 Jan-Dec;22:17455057261470175. doi: 10.1177/17455057261470175. Epub 2026 Jul 17.

ABSTRACT

BackgroundMaternal mortality in the United States has doubled over the last two decades, primarily due to cardiovascular disease, with more than half of deaths occurring postpartum. Despite national calls to action, attendance at postpartum clinic visits remains low. The role of alternative care delivery strategies, such as home visiting, remains insufficiently studied.ObjectiveTo describe postpartum clinic visit attendance among participants in a large national home visiting program, identify sociodemographic and clinical factors associated with attendance, and examine how timing and duration of enrollment relate to postpartum follow-up.DesignWe conducted a retrospective cohort study of pregnancy episodes among mothers enrolled in the Parents as Teachers (PAT) national home visiting program between July 2016 and September 2024.MethodsThe primary outcome was documented attendance at a postpartum clinic visit within 12 weeks of delivery. Descriptive analyses estimated overall attendance rates and characterized variation by pregnancy risk status, geography, calendar year, and sequential pregnancies. Multilevel logistic regression with random intercepts for participant and site was used to account for repeated pregnancies and clustering. Sensitivity analyses included all pregnancies, including those exiting home visiting prior to 12 weeks postpartum.ResultsAmong 46,899 pregnancy episodes from 39,498 participants, median maternal age was 27 years (IQR 18-36). Overall, 30.1% (95% CI 29.6-30.5) attended a postpartum clinic visit within 12 weeks, including 33.2% (95% CI 32.3-34.1) among high-risk pregnancies. Attendance was lower among Black (adjusted OR 0.80 [95% CI 0.75-0.86]), American Indian/Alaska Native (0.61 [0.55-0.68]), rural participants (0.77 [0.73-0.82]), and participants who primarily used the emergency room or urgent care for medical care before pregnancy (0.78 [0.72-0.85]). Attendance washigher among recent immigrants (1.17 [1.05-1.30]), women with high-risk pregnancies (1.13 [1.06, 1.20]),and those enrolled prenatally (1.93 [1.84-2.04]).ConclusionsPostpartum clinic attendance was low in this national home visiting cohort. Prenatal and sustained engagement in home visiting were associated with higher odds of attendance. Home visiting is a potential complementary care model to extend early care beyond clinical settings and promote sustained engagement in clinical follow-up.

PMID:42467419 | DOI:10.1177/17455057261470175

Am J Cardiovasc Drugs. 2026 Jul 17. doi: 10.1007/s40256-026-00814-8. Online ahead of print.

ABSTRACT

BACKGROUND: Sodium-glucose cotransporter 2 (SGLT2) inhibitors provide cardiovascular benefits in diabetes, but their role in the acute post-myocardial infarction (MI) setting is uncertain. This study evaluated the association of empagliflozin with left ventricular ejection fraction (LVEF) recovery and major adverse cardiac events (MACE) in patients with ST-elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI).

METHODS: In a single-center, double-blind, randomized, placebo-controlled trial, patients with STEMI were randomized to empagliflozin 10 mg or placebo daily for 40 days. The primary endpoint was change in left ventricular ejection fraction (LVEF) from baseline to day 40, with sample size calculated a priori based on data from the EMMY trial (minimum 27 per group; 53 per group enrolled). Major adverse cardiac events (MACE)-defined as cardiovascular death, myocardial infarction, or stroke-were assessed as a secondary exploratory endpoint.

RESULTS: A total of 117 patients were randomized (59 empagliflozin, 58 placebo), of whom 106 completed follow-up and were analyzed (53 per group). Empagliflozin was associated with significantly greater LVEF recovery at day 40 (mean increase: 7.35% ± 6.11% versus 2.96% ± 5.49%; mean difference 4.39%, 95% CI 2.09-6.70%; P = 0.000272), which remained significant after adjustment for baseline LVEF, age, sex, and diabetes status (adjusted difference: 3.44%, 95% CI 1.22-5.66%; P = 0.003; Cohen’s d = 0.756). The benefit was numerically greater in younger and nondiabetic patients, though no subgroup interaction reached significance after multiplicity correction. MACE did not differ significantly between groups (3.8 versus 7.5%; P = 0.68), with no recurrent MI or stroke in either group. Adverse events were rare and comparable, with no diabetic ketoacidosis, amputation, or acute kidney injury observed.

CONCLUSIONS: In this preliminary single-center trial, empagliflozin was associated with significantly greater LVEF recovery in patients with STEMI after PCI, with effects robust to covariate adjustment, and without increasing adverse events. Although MACE was not significantly reduced-as expected given the study was not powered for hard clinical events-the LVEF improvement represents a promising early prognostic signal. These findings are applicable to lower-risk patients with STEMI with successful reperfusion and may not generalize to higher-risk patients with failed PCI or hemodynamic compromise. Larger, adequately powered, long-term multicenter trials are needed to confirm clinical benefits.

TRIAL REGISTRATION: Registered at the Iranian Registry of Clinical Trials identifier no. IRCT20220809055645N7.

PMID:42467386 | DOI:10.1007/s40256-026-00814-8

Eur J Clin Microbiol Infect Dis. 2026 Jul 17. doi: 10.1007/s10096-026-05596-0. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the effect of 2% chlorhexidine gluconate (2%CHG) bathing every other day on the number of infections, catheter-related bloodstream infections (CLABSI), average length of stay, and number of deaths.

METHODS: This is a systematic review and meta-analysis. The searches and data extraction were performed by two independent authors in six databases in February 2026. We calculated Risk Ratios (RR) and Mean Difference (MD) with 95% confidence intervals for all analyses.

RESULTS: Three studies were eligible for inclusion, comprising one randomized study, one quasi-experimental study, and one observational study, with a total population of 4,943 patients. There was no statistically significant difference between the 2% CHG and the control group for CLABSI (RR 0.98 [95% CI: 0.72; 1.31], p = 0.87, I² = 0%), Gram-positive infections (RR 0.99 [95% CI: 0.45; 2.20], p = 0.98, I² = 11%), Gram-negative infections (RR 1.23 [95% CI: 0.76; 1.99], p = 0.39, I² = 0%), CRAB infections (RR 1.79 [95% CI: 0.54; 5.92], p = 0.34; I²=78%) or VRE infections (RR 0.53 [95% CI: 0.20; 1.42], p = 0.21, I²=0%), Similarly, alternate-day 2%CHG bathing was not associated with a significant reduction in ICU length of stay (MD 0.62 [95% CI: -0.29; 1.52], p = 0.18, I² = 45%), hospital length of stay (MD 7.92 [95% CI: -1.92; 17.76], p = 0.11, I² = 79%), ICU deaths (RR 1.02 [95%CI 0.88; 1.19]; p = 0.77; I² = 0%), or in-hospital deaths (RR 1.01 [95%CI 0.91; 1.12]; p = 0.84; I²=0%).

CONCLUSION: Given that only three studies were available for inclusion and that the certainty of evidence ranged from low to very low, no definitive conclusions can currently be drawn regarding the effectiveness of alternate-day 2% CHG bathing in critically ill patients.

PMID:42467378 | DOI:10.1007/s10096-026-05596-0