氯己定抗菌剂显著降低了外科婴儿肠外营养期间脓毒症和败血症的发生率。

Chlorhexidine antisepsis significantly reduces the incidence of sepsis and septicemia during parenteral nutrition in surgical infants.

机构信息

Surgery Unit, University College London Institute of Child Health and Great Ormond Street Hospital for Children, London WC1N 1EH, United Kingdom.

出版信息

J Pediatr Surg. 2011 Jun;46(6):1064-9. doi: 10.1016/j.jpedsurg.2011.03.028.

DOI:10.1016/j.jpedsurg.2011.03.028

PMID:21683199

Abstract

BACKGROUND/PURPOSE: After a change in national policy, central venous catheter (CVC) antisepsis with chlorhexidine was introduced in our hospital. Our aim was to evaluate whether this change reduced the rate of infection seen during parenteral nutrition (PN) in infants requiring gastrointestinal surgery.

METHODS

Two groups of consecutive infants were compared: control, 98 infants who had CVC antisepsis with 70% isopropanol alone, and chlorhexidine, 112 infants who had CVC antisepsis with 2% chlorhexidine in 70% isopropanol. Incidence rates of sepsis (blood cultures taken) and septicemia (blood cultures positive) were compared by Poisson regression.

RESULTS

Seventy-one percent of infants experienced clinically suspected sepsis. The incidence of septicemia was 32%. The incidence rate ratio for sepsis was 0.72 (95% confidence interval, 0.61-0.84) for the chlorhexidine group vs control (P < .0005). The incidence rate ratio for septicemia was 0.49 (95% confidence interval, 0.36-0.67; P < .0005); that is, over a given period of PN, patients had half the rate of positive blood cultures after the introduction of chlorhexidine antisepsis compared with before.

CONCLUSION

(1) The incidence of sepsis and septicemia among surgical infants on PN for gastrointestinal anomalies is high. (2) Chlorhexidine CVC antisepsis has significantly reduced this incidence, and we advocate its use in this group of patients.

摘要

背景/目的：国家政策改变后，我院开始使用洗必泰对中心静脉导管（CVC）进行消毒。我们旨在评估这种变化是否降低了胃肠外科需要肠外营养（PN）的婴儿中 CVC 相关感染的发生率。

方法

比较了两组连续的婴儿：对照组，98 例婴儿单独使用 70%异丙醇对 CVC 进行消毒；洗必泰组，112 例婴儿使用 70%异丙醇中的 2%洗必泰对 CVC 进行消毒。采用泊松回归比较两组的败血症（进行血培养）和菌血症（血培养阳性）发生率。

结果

71%的婴儿出现临床疑似败血症。菌血症的发生率为 32%。与对照组相比，洗必泰组的败血症发生率比为 0.72（95%置信区间，0.61-0.84）（P<0.0005）。菌血症的发生率比为 0.49（95%置信区间，0.36-0.67；P<0.0005）；也就是说，在给定的 PN 期间，与使用洗必泰消毒前相比，使用洗必泰消毒后，患者血液培养阳性的发生率减半。