Kao Hsiang-Fong, Chen I-Chun, Hsu Chiun, Chang Sin-Yuan, Chien Shu-Fen, Chen Yee-Chun, Hu Fu-Chang, Yang James Chih-Hsin, Cheng Ann-Lii, Yeh Kun-Huei
Department of Oncology, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin, Taiwan,
Support Care Cancer. 2014 May;22(5):1189-97. doi: 10.1007/s00520-013-2071-5. Epub 2014 Jan 3.
To evaluate the preventive effects of topical skin disinfection with chlorhexidine on bloodstream infection (BSI) associated with totally implantable venous port (Port-A).
Two consecutive cohorts of solid cancer patients were prospectively followed for the occurrence of Port-A associated BSI (PABSI). The first cohort used povidone-iodine as topical skin disinfection and the second cohort used chlorhexidine. The primary endpoint was the time to first PABSI. Propensity score analysis was applied. The preventive effects of chlorhexidine were analyzed by Cox proportional hazards models.
There were 396 patients (81,752 catheter-days) in the iodine cohort and 497 (99,977 catheter-days) in the chlorhexidine cohort. Gram-negative bacteria were the most common pathogens to cause first episode of PABSI (iodine cohort (I) vs chlorhexidine cohort (C) and 0.404 vs 0.450 per 1,000 catheter-day), followed by Gram-positive bacteria (I vs C and 0.269 vs 0.110 per 1,000 catheter-day), and fungi (I vs C and 0.098 vs 0.070 per 1,000 catheter-day). Three hundred forty-three patients were selected from each cohort by propensity score match analysis. Chlorhexidine use was associated with a significant improvement on time to first PABSI caused by Gram-positive bacteria (log-rank test, p=0.00175; HR=0.35, 95 % CI, 0.14-0.85, p=0.02). No significant preventive effects of chlorhexidine on time to first PABSI caused by Gram-negative bacteria or fungi was found.
Chlorhexidine topical skin disinfection may prevent PABSI caused by Gram-positive bacteria in patients with solid cancers. The nonsignificant effect on preventing overall PABSI may be attributed to the high incidence of Gram-negative bacteria related PABSI.
评估洗必泰局部皮肤消毒对与完全植入式静脉端口（输液港）相关的血流感染（BSI）的预防效果。
对连续两个队列的实体癌患者进行前瞻性随访，观察输液港相关血流感染（PABSI）的发生情况。第一个队列使用聚维酮碘进行局部皮肤消毒，第二个队列使用洗必泰。主要终点是首次发生PABSI的时间。应用倾向评分分析。通过Cox比例风险模型分析洗必泰的预防效果。
碘剂队列有396例患者（导管日81,752天），洗必泰队列有497例患者（导管日共99,977天）。革兰氏阴性菌是导致首次PABSI发作的最常见病原体（碘剂队列（I）与洗必泰队列（C），每1000导管日分别为0.404和0.450），其次是革兰氏阳性菌（I与C，每1000导管日分别为0.269和0.110），以及真菌（I与C，每1000导管日分别为0.098和0.070）。通过倾向评分匹配分析从每个队列中选择了343例患者。使用洗必泰与革兰氏阳性菌引起的首次PABSI时间显著改善相关（对数秩检验，p = 0.00175；HR = 0.35，95%CI，0.14 - 0.85，p = 0.02）。未发现洗必泰对革兰氏阴性菌或真菌引起的首次PABSI时间有显著预防效果。
洗必泰局部皮肤消毒可能预防实体癌患者由革兰氏阳性菌引起的PABSI。对预防总体PABSI无显著效果可能归因于革兰氏阴性菌相关PABSI的高发生率。
