医用级蜂蜜不能减少重症患者中心静脉导管插入部位的皮肤定植：一项随机对照试验。
Medical-grade honey does not reduce skin colonization at central venous catheter-insertion sites of critically ill patients: a randomized controlled trial.
作者信息
Kwakman Paulus H, Müller Marcella C, Binnekade Jan M, van den Akker Johannes P, de Borgie Corianne A, Schultz Marcus J, Zaat Sebastian A
出版信息
Crit Care. 2012 Oct 30;16(5):R214. doi: 10.1186/cc11849.
INTRODUCTION
Catheter-related bloodstream infections (CRBSIs) associated with short-term central venous catheters (CVCs) in intensive care unit (ICU) patients are a major clinical problem. Bacterial colonization of the skin at the CVC insertion site is an important etiologic factor for CRBSI. The aim of this study was to assess the efficacy of medical-grade honey in reducing bacterial skin colonization at insertion sites.
METHODS
A prospective, single-center, open-label randomized controlled trial was performed at the ICU of a university hospital in The Netherlands to assess the efficacy of medical-grade honey to reduce skin colonization of insertion sites. Medical-grade honey was applied in addition to standard CVC-site dressing and disinfection with 0.5% chlorhexidine in 70% alcohol. Skin colonization was assessed on a daily basis before CVC-site disinfection. The primary end point was colonization of insertion sites with >100 colony-forming units at the last sampling before removal of the CVC or transfer of the patient from the ICU. Secondary end points were quantitative levels of colonization of the insertion sites and colonization of insertion sites stratified for CVC location.
RESULTS
Colonization of insertion sites was not affected by the use of medical-grade honey, as 44 (34%) of 129 and 36 (34%) of 106 patients in the honey and standard care groups, respectively, had a positive skin culture (P = 0.98). Median levels of skin colonization at the last sampling were 1 (0 to 2.84) and 1 (0 to 2.70) log colony-forming units (CFUs)/swab for the honey and control groups, respectively (P = 0.94). Gender, days of CVC placement, CVC location, and CVC type were predictive for a positive skin culture. Correction for these variables did not change the effect of honey on skin-culture positivity.
CONCLUSIONS
Medical-grade honey does not affect colonization of the skin at CVC insertion sites in ICU patients when applied in addition to standard disinfection with 0.5% chlorhexidine in 70% alcohol.
TRIAL REGISTRATION
Netherlands Trial Registry, NTR1652.
引言
重症监护病房（ICU）患者中与短期中心静脉导管（CVC）相关的导管相关血流感染（CRBSI）是一个主要的临床问题。CVC插入部位皮肤的细菌定植是CRBSI的一个重要病因。本研究的目的是评估医用级蜂蜜在减少插入部位细菌皮肤定植方面的疗效。
方法
在荷兰一家大学医院的ICU进行了一项前瞻性、单中心、开放标签的随机对照试验，以评估医用级蜂蜜减少插入部位皮肤定植的疗效。除了使用标准的CVC部位敷料和用0.5%氯己定酒精进行消毒外，还应用了医用级蜂蜜。在CVC部位消毒前每天评估皮肤定植情况。主要终点是在拔除CVC或患者转出ICU前的最后一次采样时，插入部位定植菌>100菌落形成单位。次要终点是插入部位定植的定量水平以及根据CVC位置分层的插入部位定植情况。
结果
使用医用级蜂蜜对插入部位的定植没有影响，蜂蜜组和标准护理组分别有44例（34%）和36例（34%）患者的皮肤培养呈阳性（P = 0.98）。蜂蜜组和对照组在最后一次采样时皮肤定植的中位数水平分别为1（0至2.84）和1（0至2.70）log菌落形成单位（CFU）/拭子（P = 0.94）。性别、CVC放置天数、CVC位置和CVC类型可预测皮肤培养呈阳性。对这些变量进行校正并没有改变蜂蜜对皮肤培养阳性的影响。
结论
当除了用0.5%氯己定酒精进行标准消毒外还应用医用级蜂蜜时，其对ICU患者CVC插入部位的皮肤定植没有影响。
试验注册
荷兰试验注册中心，NTR1652。
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