Segers Patrique, Speekenbrink Ron G H, Ubbink Dirk T, van Ogtrop Marc L, de Mol Bas A
Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
JAMA. 2006 Nov 22;296(20):2460-6. doi: 10.1001/jama.296.20.2460.
Nosocomial infections are an important cause of morbidity and mortality after cardiac surgery. Decolonization of endogenous potential pathogenic microorganisms is important in the prevention of nosocomial infections.
To determine the efficacy of perioperative decontamination of the nasopharynx and oropharynx with 0.12% chlorhexidine gluconate for reduction of nosocomial infection after cardiac surgery.
DESIGN, SETTING, AND PARTICIPANTS: A prospective, randomized, double-blind, placebo-controlled clinical trial conducted at the Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands, between August 1, 2003, and September 1, 2005. Of 991 patients older than 18 years undergoing elective cardiothoracic surgery during the study interval, 954 were eligible for analysis.
Oropharyngeal rinse and nasal ointment containing either chlorhexidine gluconate or placebo.
Incidence of nosocomial infection, in addition to the rate of Staphylococcus aureus nasal carriage and duration of hospital stay.
The incidence of nosocomial infection in the chlorhexidine gluconate group and placebo group was 19.8% and 26.2%, respectively (absolute risk reduction [ARR], 6.4%; 95% confidence interval [CI], 1.1%-11.7%; P = .002). In particular, lower respiratory tract infections and deep surgical site infections were less common in the chlorhexidine gluconate group than in the placebo group (ARR, 6.5%; 95% CI, 2.3%-10.7%; P = .002; and 3.2%; 95% CI, 0.9%-5.5%; P = .002, respectively). For the prevention of 1 nosocomial infection, 16 patients needed to be treated with chlorhexidine gluconate. A significant reduction of 57.5% in S aureus nasal carriage was found in the chlorhexidine gluconate group compared with a reduction of 18.1% in the placebo group (P<.001). Total hospital stay for patients treated with chlorhexidine gluconate was 9.5 days compared with 10.3 days in the placebo group (ARR, 0.8 days; 95% CI, 0.24-1.88; P = .04).
Decontamination of the nasopharynx and oropharynx with chlorhexidine gluconate appears to be an effective method to reduce nosocomial infection after cardiac surgery.
clinicaltrials.gov Identifier: NCT00272675.
医院感染是心脏手术后发病和死亡的重要原因。对内源性潜在致病微生物进行去定植在预防医院感染中很重要。
确定用0.12%葡萄糖酸氯己定对鼻咽和口咽进行围手术期去污以降低心脏手术后医院感染的疗效。
设计、地点和参与者：2003年8月1日至2005年9月1日在荷兰阿姆斯特丹的翁泽利夫弗劳韦加斯huis进行的一项前瞻性、随机、双盲、安慰剂对照临床试验。在研究期间，991例年龄超过18岁接受择期心胸手术的患者中，954例符合分析条件。
含葡萄糖酸氯己定或安慰剂的口咽冲洗液和鼻软膏。
医院感染发生率，以及金黄色葡萄球菌鼻腔携带率和住院时间。
葡萄糖酸氯己定组和安慰剂组的医院感染发生率分别为19.8%和26.2%（绝对风险降低率[ARR]为6.4%；95%置信区间[CI]为1.1%-11.7%；P = 0.002）。特别是，葡萄糖酸氯己定组的下呼吸道感染和深部手术部位感染比安慰剂组少见（ARR分别为6.5%；95%CI为2.3%-10.7%；P = 0.002；以及3.2%；95%CI为0.9%-5.5%；P = 0.002）。为预防1例医院感染，需要16例患者用葡萄糖酸氯己定治疗。与安慰剂组18.1%的降低率相比，葡萄糖酸氯己定组金黄色葡萄球菌鼻腔携带率显著降低57.5%（P<0.001）。葡萄糖酸氯己定治疗的患者总住院时间为9.5天，而安慰剂组为10.3天（ARR为0.8天；95%CI为0.24-1.88；P = 0.04）。
用葡萄糖酸氯己定对鼻咽和口咽进行去污似乎是降低心脏手术后医院感染的有效方法。
clinicaltrials.gov标识符：NCT00272675。
