氯己定沐浴对外科重症监护病房抗菌药物利用的影响。

Impact of Chlorhexidine Bathing on Antimicrobial Utilization in Surgical Intensive Care Unit.

机构信息

Department of Pharmacy Practice, Samford University McWhorter School of Pharmacy, Birmingham, Alabama; Houston Methodist Research Institute, Houston, Texas.

Houston Methodist Research Institute, Houston, Texas; Department of Pharmacy Services, Houston Methodist Hospital, Houston, Texas; Department of Surgery, Houston Methodist Hospital, Houston, Texas.

出版信息

J Surg Res. 2020 Jun;250:161-171. doi: 10.1016/j.jss.2019.12.049. Epub 2020 Feb 15.

DOI:10.1016/j.jss.2019.12.049

PMID:32065967

Abstract

BACKGROUND

This secondary analysis compared antimicrobial utilization among surgical intensive care unit patients randomized to every other day chlorhexidine bathing (chlorhexidine) versus daily soap and water bathing (soap-and-water) using data from the CHlorhexidine Gluconate BATHing trial.

MATERIALS AND METHODS

Antimicrobial utilization was quantified using defined daily dose (DDD)/100 patient-days and agent-days/100 patient-days for systemic antimicrobials. Antivirals (except oseltamivir), antiparasitics, and prophylaxis agents were excluded. The 2018 anatomic therapeutic chemical/DDD index was used to calculate DDD. Agent-days were calculated as the sum of calendar days where antimicrobials were administered. Patient-days were defined as time patients were at risk for health care-acquired infections plus up to 14 d. Primary analyses were conducted using linear regression adjusted for baseline Acute Physiology and Chronic Health Evaluation II scores.

RESULTS

Of 325 CHlorhexidine Gluconate BATHing trial patients, 312 (157 in soap-and-water and 155 in chlorhexidine) were included. The median (interquartile range) of total antimicrobial DDD/100 patient-days was 135.4 (75.2-231.8) for soap-and-water and 129.9 (49.2-215.3) for chlorhexidine. The median (interquartile range) of total antimicrobial agent-days/100 patient-days was 155.6 (83.3-243.2) for soap-and-water and 146.7 (66.7-217.4) for chlorhexidine. After adjusting for Acute Physiology and Chronic Health Evaluation II scores, chlorhexidine bathing was associated with a nonsignificant reduction in total antimicrobial DDD/100 patient-days (-3.9; 95% confidence interval, -33.9 to 26.1; P = 0.80) and total antimicrobial agent-days/100 patient-days (-10.3; 95% confidence interval, -34.7 to 14.1; P = 0.41).

CONCLUSIONS

Compared with daily soap and water bathing, every other day chlorhexidine bathing did not significantly reduce total antimicrobial utilization in surgical intensive care unit patients.

摘要

背景

本二次分析比较了接受隔日氯己定沐浴（氯己定）与每日肥皂和水沐浴（肥皂和水）的外科重症监护病房患者的抗菌药物使用情况，数据来自氯己定葡萄糖酸盐沐浴试验。

材料和方法

使用限定日剂量（DDD）/100 患者日和系统抗菌药物的药物日/100 患者日来量化抗菌药物的使用情况。排除抗病毒药物（奥司他韦除外）、抗寄生虫药和预防用药。使用 2018 年解剖治疗化学/DDD 索引计算 DDD。药物日的计算方法是给予抗菌药物的日历日数之和。患者日定义为患者存在获得性医院感染风险的时间加上最多 14 天。主要分析采用线性回归，根据基线急性生理学和慢性健康评估 II 评分进行调整。

结果

在 325 例氯己定葡萄糖酸盐沐浴试验患者中，312 例（肥皂和水组 157 例，氯己定组 155 例）纳入分析。肥皂和水组总抗菌药物 DDD/100 患者日的中位数（四分位距）为 135.4（75.2-231.8），氯己定组为 129.9（49.2-215.3）。肥皂和水组总抗菌药物日/100 患者日的中位数（四分位距）为 155.6（83.3-243.2），氯己定组为 146.7（66.7-217.4）。在调整急性生理学和慢性健康评估 II 评分后，氯己定沐浴与总抗菌药物 DDD/100 患者日无显著减少（-3.9；95%置信区间，-33.9 至 26.1；P=0.80）和总抗菌药物日/100 患者日（-10.3；95%置信区间，-34.7 至 14.1；P=0.41）。