Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Center of Excellence for Pediatric Infectious Diseases and Vaccines, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Pediatr Int. 2020 Jul;62(7):789-796. doi: 10.1111/ped.14200. Epub 2020 Jul 9.
Central line-associated bloodstream infections (CLABSIs) are important hospital-acquired infections. Chlorhexidine-impregnated dressings (also known as chlorhexidine patches, CHG patches) are reported to decrease CLABSIs in adults. This study aims to determine the efficacy of CHG patches in reducing CLABSIs in children.
An open-label randomized controlled trial was conducted in children aged 2 months to 18 years, requiring a short-term catheter. Patients were randomized into two groups, allocated to receive CHG patches or standard transparent dressings. Care of the catheter was in accordance with Asia Pacific Society of Infection Control (APSIC) recommendations. Central-line-associated bloodstream infections were defined using National Healthcare Safety Network surveillance criteria.
From April 2017 to April 2018, 192 children were enrolled. There were 108 CHG patch catheters and 101 standard dressing catheters, contributing to 3,113 catheter days. The median duration of catheter dwelling was 13 days, with an interquartile range (IQR) of 8-20 days. Half were placed at the jugular vein and 22% at the femoral vein. There were 23 CLABSI events. Incidence rates for CHG patches and standard dressings were 7.98 (95% confidence interval (CI), 4.25-13.65) and 6.74 (95% CI, 3.23-12.39) per 1,000 catheter days, respectively (incidence rate ratio 1.18; 95% CI, 0.52-2.70). The CLABSI pathogens were 15 Gram-negative bacteria, six Gram-positive bacteria, and two Candida organisms. Catheter colonization of CHG patches and standard dressings were 2.02 (95% CI, 0.42-5.91) and 3.07 (95% CI, 1.00-7.16) per 1,000 catheter days, respectively. Only local adverse effects occurred in 6.8% of the participants.
In our setting, there was no difference in CLABSI rates when the chlorhexidine patch dressings were compared with the standard transparent dressings. Strengthening of CLABSI prevention bundles is mandatory.
中心静脉相关血流感染（CLABSIs）是重要的医院获得性感染。氯己定浸渍敷料（也称为氯己定贴片，CHG 贴片）据报道可降低成人的 CLABSIs。本研究旨在确定 CHG 贴片在降低儿童 CLABSIs 中的疗效。
在需要短期导管的 2 个月至 18 岁的儿童中进行了一项开放性随机对照试验。患者被随机分为两组，分别接受 CHG 贴片或标准透明敷料。导管的护理符合亚太感染控制学会（APSIC）的建议。中心静脉相关血流感染采用国家医疗保健安全网络监测标准定义。
2017 年 4 月至 2018 年 4 月，共纳入 192 例患儿。有 108 例 CHG 贴片导管和 101 例标准敷料导管，共计 3113 天导管留置。导管留置的中位数为 13 天，四分位间距（IQR）为 8-20 天。其中一半位于颈静脉，22%位于股静脉。发生了 23 例 CLABSI 事件。CHG 贴片和标准敷料的发生率分别为 7.98（95%置信区间（CI），4.25-13.65）和 6.74（95%CI，3.23-12.39）/1000 天导管（发病率比 1.18；95%CI，0.52-2.70）。CLABSI 的病原体为 15 株革兰氏阴性菌、6 株革兰氏阳性菌和 2 株假丝酵母菌。CHG 贴片和标准敷料的导管定植率分别为 2.02（95%CI，0.42-5.91）和 3.07（95%CI，1.00-7.16）/1000 天导管（比值比 1.18；95%CI，0.52-2.70）。仅 6.8%的参与者出现局部不良反应。
在我们的环境中，与标准透明敷料相比，氯己定贴片敷料并未降低 CLABSI 发生率。必须加强 CLABSI 预防措施。
