Department of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
Department of Medicine, The University of Queensland, Queensland, Australia.
J Hosp Infect. 2019 Nov;103(3):284-292. doi: 10.1016/j.jhin.2019.08.004. Epub 2019 Aug 9.
Healthcare-associated infections (HAIs) caused by multi-drug-resistant Gram-negative bacteria (MDRGNB) have increased prevalence in intensive care units (ICUs). A common strategy to prevent HAIs is bathing patients with chlorhexidine gluconate (CHG). However, the effectiveness of CHG bathing against multidrug-resistant Acinetobacter baumannii (MDRAB) is still controversial. The aim of this study was to perform a systematic review and meta-analysis of the effectiveness of CHG bathing on Acinetobacter baumannii colonization and infection in the ICU setting. A systematic literature search of PubMed, EMBASE, Web of Science and CINAHL was performed from inception through to June 2018. Randomized controlled trials (RCTs), pre-post studies, or interrupted time series (ITS) studies were included. The numbers of patients with/without colonization or infection of A. baumannii in the experimental or control groups were extracted from each study. Quality assessment was performed by the related instruments of National Institute of Health. Pooled risk ratios (RRs) were calculated using the random-effects model. One RCT and 12 pre-post or ITS studies comprising 18,217 patients were included, of which 8069 were in the CHG bathing arm and 9051 in the control arm. CHG bathing was associated with a reduced colonization of A. baumannii (RR, 0.66; 95% confidence interval: 0.57-0.77; P<0.001). Chlorhexidine at 4% showed a better effect than 2% chlorhexidine (meta-regression P=0.044). CHG bathing was associated with a non-significant reduction of infection (pooled RR 0.41, 95% CI: 0.13-1.25). This study suggests that CHG bathing significantly reduces colonization of A. baumannii in the ICU setting. However, more trials are needed to confirm whether CHG bathing can reduce infections with A. baumannii.
医疗机构相关性感染（HAI）由耐多药革兰氏阴性菌（MDRGNB）引起，在重症监护病房（ICU）中发病率增加。预防 HAI 的常用策略是用葡萄糖酸洗必泰（CHG）为患者沐浴。然而，CHG 沐浴对多重耐药鲍曼不动杆菌（MDRAB）的有效性仍存在争议。本研究旨在对 ICU 环境中 CHG 沐浴对鲍曼不动杆菌定植和感染的有效性进行系统评价和荟萃分析。对 PubMed、EMBASE、Web of Science 和 CINAHL 进行了系统的文献检索，检索时间从建库至 2018 年 6 月。纳入随机对照试验（RCT）、前后研究或中断时间序列（ITS）研究。从每项研究中提取实验组和对照组中患有/未患有鲍曼不动杆菌定植或感染的患者人数。采用国立卫生研究院的相关工具进行质量评估。使用随机效应模型计算汇总风险比（RR）。纳入了一项 RCT 和 12 项前后研究或 ITS 研究，共 18217 例患者，其中 CHG 沐浴组 8069 例，对照组 9051 例。CHG 沐浴与鲍曼不动杆菌定植减少相关（RR，0.66；95%置信区间：0.57-0.77；P<0.001）。4%的洗必泰比 2%洗必泰效果更好（meta 回归 P=0.044）。CHG 沐浴与感染的非显著降低相关（汇总 RR 0.41，95%CI：0.13-1.25）。本研究表明，CHG 沐浴可显著降低 ICU 中鲍曼不动杆菌的定植。然而，还需要更多的试验来证实 CHG 沐浴是否可以减少鲍曼不动杆菌感染。
