Nascimento Teresa, Inácio João, Guerreiro Daniela, Patrício Patrícia, Proença Luís, Toscano Cristina, Diaz Priscila, Barroso Helena
School of Health & Science, Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz, Caparica, Almada, 2829-511, Portugal.
School of Applied Sciences, University of Brighton, Brighton, UK.
Antimicrob Resist Infect Control. 2025 Jul 9;14(1):87. doi: 10.1186/s13756-025-01606-6.
Chlorhexidine Gluconate (CHG) bathing is widely used in Intensive Care Units (ICUs) to reduce bacterial colonisation, yet its efficacy against fungal skin colonisation, particularly Candida spp., is not well understood. This study aimed to evaluate the impact of daily CHG bathing on Candida colonisation among ICU patients.
From 2020 to 2022, axillary/inguinal swabs were collected from 675 ICU patients across three units on admission (Day 1, D1), Day 5 (D5) and Day 8 (D8). Patients received daily CHG bathing (either 2% impregnated wipes or 4% liquid solution) from D1 to D5, followed by soap-and-water bathing from Day 6 to D8. Standard and molecular microbiological methods were used to identify fungal species, and colony-forming units (CFUs) were quantified. Colonisation rates and fungal burden were compared across time points and bathing protocols.
A total of 988 swabs from 675 patients were collected, 675 on D1, 203 on D5 and 110 on D8. CHG bathing had no significant impact on Candida burden at individual time points, (D1, p = 0.223; D5, p = 0.939 and D8, p = 0.669). No significant differences in colonisation or fungal burden were observed between the use of 4% CHG solution and 2% CHG-impregnated wipes upon ICU admission. However, in the subgroup of 89 patients monitored longitudinally, a transient reduction in colonisation was observed during the CHG bathing period (D1-D5), followed by a significant increase during the soap-and-water period (D6-D8) (p = 0.005; between periods: p < 0.001). Among the 329 positive swabs, 274 yielded > 100 CFU/ml. High colony counts of C. albicans (> 1000 CFU/mL) were observed, with no significant association between colonisation levels and specific Candida species (p = 0.940).
CHG bathing demonstrated only a limited and transient impact on Candida colonisation in ICU patients. Colonisation rates rebounded after cessation of CHG use, suggesting ongoing acquisition during ICU stay. These findings highlight the need for additional or alternative infection control measures targeting fungal pathogens in critical care settings.
葡萄糖酸氯己定（CHG）沐浴在重症监护病房（ICU）中广泛用于减少细菌定植，但其对真菌皮肤定植，尤其是念珠菌属的疗效尚不清楚。本研究旨在评估每日CHG沐浴对ICU患者念珠菌定植的影响。
2020年至2022年，在入院时（第1天，D1）、第5天（D5）和第8天（D8）从三个科室的675例ICU患者中采集腋窝/腹股沟拭子。患者从D1至D5接受每日CHG沐浴（2%浸渍湿巾或4%液体溶液），随后从第6天至D8进行肥皂和水沐浴。采用标准和分子微生物学方法鉴定真菌种类，并对菌落形成单位（CFU）进行定量。比较不同时间点和沐浴方案的定植率和真菌负荷。
共收集了675例患者的988份拭子，D1时675份，D5时203份，D8时110份。CHG沐浴在各个时间点对念珠菌负荷均无显著影响（D1，p = 0.223；D5，p = 0.939；D8，p = 0.669）。在ICU入院时，使用4% CHG溶液和2% CHG浸渍湿巾之间在定植或真菌负荷方面未观察到显著差异。然而，在纵向监测的89例患者亚组中，在CHG沐浴期间（D1 - D5）观察到定植短暂减少，随后在肥皂和水沐浴期间（D6 - D8）显著增加（p = 0.005；不同时期之间：p < 0.001）。在329份阳性拭子中，274份产生的菌落数>100 CFU/ml。观察到白色念珠菌的高菌落数（>1000 CFU/mL），定植水平与特定念珠菌种类之间无显著关联（p = 0.940）。
CHG沐浴对ICU患者念珠菌定植仅显示出有限且短暂的影响。停止使用CHG后定植率反弹，表明在ICU住院期间持续有感染源。这些发现凸显了在重症监护环境中针对真菌病原体采取额外或替代感染控制措施的必要性。
