Urbancic Karen F, Mårtensson Johan, Glassford Neil, Eyeington Christopher, Robbins Raymond, Ward Peter B, Williams Darren, Johnson Paul Dr, Bellomo Rinaldo
Department of Infectious Diseases, Austin Hospital, Melbourne, Vic, Australia.
Department of Intensive Care, Austin Hospital, Melbourne, Vic, Australia.
Crit Care Resusc. 2018 Jun;20(2):109-116.
Chlorhexidine gluconate (CHG) bathing has been reported to decrease bloodstream infections and colonisation of multidrug-resistant organisms (MROs) in intensive care units (ICUs). However, its effectiveness in an Australian setting has not been assessed.
To test whether the introduction of ICU-wide CHG bathing in place of triclosan would affect rates of the primary outcome of central line-associated bloodstream infections (CLABSI), or the secondary outcomes of ICU-acquired positive blood cultures or other clinical specimens, and MRO colonisation including methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE).
We conducted a single-centre, sequential, before-and-after observational study. Patient microbiological and clinical data were compared in the 12 months before and after the introduction of CHG bathing in the ICU.
A total of 4262 ICU admissions were studied, 2117 before and 2145 during the CHG-bathing period. There were no significant changes in the rates of CLABSI (from 1.69/1000 central venous catheter-days [95% CI, 0.68-3.48] to 1.33 [95% CI, 0.49-2.90]; P = 0.68), or ICU-acquired positive blood cultures (from 5.14/1000 patientdays [95% CI, 3.45-7.39] to 4.45 [95% CI, 3.00-6.36]; P = 0.58). However, we observed a lower incidence of MRSA acquisition during the CHG-bathing period (mean difference, -2.13 [95% CI, -3.65 to -0.60] per 1000 patient-days; P = 0.007). There was no difference in the rate of isolates involving other pathogens including VRE.
In a tertiary Australian ICU, routine CHG bathing compared with triclosan did not affect the rates of ICU-acquired CLABSI or positive blood cultures. However, it significantly decreased the incidence of MRSA acquisition.
据报道，在重症监护病房（ICU）中使用葡萄糖酸氯己定（CHG）沐浴可减少血流感染及多重耐药菌（MRO）的定植。然而，其在澳大利亚环境中的有效性尚未得到评估。
测试在ICU中全面引入CHG沐浴以替代三氯生是否会影响中心静脉导管相关血流感染（CLABSI）的主要结局发生率，或ICU获得性血培养阳性或其他临床标本的次要结局发生率，以及MRO定植，包括耐甲氧西林金黄色葡萄球菌（MRSA）和耐万古霉素肠球菌（VRE）。
我们进行了一项单中心、前后序贯观察性研究。对ICU引入CHG沐浴前后12个月的患者微生物学和临床数据进行了比较。
共研究了4262例ICU入院患者，CHG沐浴前2117例，CHG沐浴期间2145例。CLABSI发生率（从1.69/1000中心静脉导管日[95%CI，0.68 - 3.48]降至1.33[95%CI，0.49 - 2.90]；P = 0.68）或ICU获得性血培养阳性率（从5.14/1000患者日[95%CI，3.45 - 7.39]降至4.45[95%CI，3.00 - 6.36]；P = 0.58）均无显著变化。然而，我们观察到CHG沐浴期间MRSA获得的发生率较低（平均差异，每1000患者日-2.13[95%CI，-3.65至-0.60]；P = 0.007）。涉及其他病原体（包括VRE）的分离率没有差异。
在澳大利亚一家三级ICU中，与三氯生相比，常规CHG沐浴并未影响ICU获得性CLABSI或血培养阳性率。然而，它显著降低了MRSA获得的发生率。
