Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Hindenburgdamm 27, 12203, Berlin, Germany.
National Reference Center for the Surveillance of Nosocomial Infections, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
Antimicrob Resist Infect Control. 2023 Jun 3;12(1):55. doi: 10.1186/s13756-023-01260-w.
Antiseptic bathing did not reduce central-line (CL) associated bloodstream infection (CLABSI) rates in intensive care units (ICU) according to a recent cluster randomised controlled trial (cRCT). However, this analysis did not consider baseline infection rates. Our post-hoc analysis of this cRCT aimed to use a before-after comparison to examine the effect of daily bathing with chlorhexidine, octenidine or water and soap (control) on ICU-attributable CLABSI rates.
A post-hoc analysis of a multi-center cRCT was done. ICUs that did not yet perform routine antiseptic bathing were randomly assigned to one of three study groups applying daily bathing with 2% chlorhexidine-impregnated cloths, 0.08% octenidine wash mitts or water and soap (control) for 12 months. Baseline data was assessed 12 months before the intervention started when all ICUs routinely used water and soap. Poisson regression and generalised estimating equation models were applied to identify changes of CLABSI rates per 1000 CL days between intervention and baseline periods in each study group.
The cRCT was conducted in 72 ICUs (24 per study group) including 76,139 patients in the baseline and 76,815 patients in the intervention period. In the chlorhexidine group, incidence density of CLABSI was reduced from 1.48 to 0.90 CLABSI per 1000 CL days comparing baseline versus intervention period (P = 0.0085). No reduction was observed in the octenidine group (1.26 versus 1.47 CLABSI per 1000 CL days, P = 0.8735) and the control group (1.20 versus 1.17, P = 0.3298). Adjusted incidence rate ratios (intervention versus baseline) were 0.63 (95%CI 0.46-0.87, P = 0.0172) in the chlorhexidine, 1.17 (95% CI 0.79-1.72, P = 0.5111) in the octenidine and 0.98 (95% CI 0.60-1.58, P = 0.9190) in the control group. Chlorhexidine bathing reduced CLABSI with gram-positive bacteria, mainly coagulase-negative staphylococci (CoNS).
In this post-hoc analysis of a cRCT, the application of 2% chlorhexidine-impregnated cloths reduced ICU-attributable CLABSI. This preventive effect of chlorhexidine was restricted to CLABSI caused by gram-positive pathogens (CoNS). In contrast, 0.08% octenidine wash mitts did not reduce CLABSI rates in ICUs. Trial registration Registration number DRKS00010475, registration date August 18, 2016.
根据最近的一项集群随机对照试验（cRCT），抗菌沐浴并不能降低重症监护病房（ICU）中中心静脉导管（CL）相关血流感染（CLABSI）的发生率。然而，该分析并未考虑基线感染率。我们对该 cRCT 的事后分析旨在使用前后对照来检查每天用洗必泰、奥替尼啶或水和肥皂（对照）洗澡对 ICU 归因性 CLABSI 发生率的影响。
对一项多中心 cRCT 进行了事后分析。尚未常规进行抗菌沐浴的 ICU 被随机分配到三个研究组之一，每天用 2%洗必泰浸渍布、0.08%奥替尼啶洗涤手套或水和肥皂（对照）沐浴 12 个月。在干预开始前的 12 个月评估基线数据，此时所有 ICU 均常规使用水和肥皂。应用泊松回归和广义估计方程模型，确定每组干预与基线期间每 1000 个 CL 天 CLABSI 发生率的变化。
该 cRCT 在 72 个 ICU（每组 24 个）中进行，包括 76139 名基线患者和 76815 名干预期间患者。在洗必泰组中，CLABSI 的发病率密度从基线时的 1.48 降至干预时的 0.90 CLABSI/1000 CL 天（P=0.0085）。奥替尼啶组（每 1000 CL 天的 CLABSI 为 1.26 与 1.47，P=0.8735）和对照组（1.20 与 1.17，P=0.3298）均未观察到降低。调整后的发病率比（干预与基线）分别为洗必泰组 0.63（95%CI 0.46-0.87，P=0.0172）、奥替尼啶组 1.17（95%CI 0.79-1.72，P=0.5111）和对照组 0.98（95%CI 0.60-1.58，P=0.9190）。洗必泰沐浴降低了革兰氏阳性菌（主要是凝固酶阴性葡萄球菌[CoNS]）引起的 CLABSI。
在这项 cRCT 的事后分析中，应用 2%洗必泰浸渍布降低了 ICU 归因性 CLABSI。洗必泰的这种预防作用仅限于由革兰氏阳性病原体（CoNS）引起的 CLABSI。相比之下，0.08%奥替尼啶洗涤手套并不能降低 ICU 中 CLABSI 的发生率。
DRKS00010475，登记日期：2016 年 8 月 18 日。
