Prospective randomized trial of 10% povidone-iodine versus 0.5% tincture of chlorhexidine as cutaneous antisepsis for prevention of central venous catheter infection
Prospective randomized trial of 10% povidone-iodine versus 0.5% tincture of chlorhexidine as cutaneous antisepsis for prevention of central venous catheter infection
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DOI：
10.1086/318145
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发表时间：
2000-10-01
影响因子：
11.8
通讯作者：
Conly, JM
中科院分区：
文献类型：
--
作者：
Humar, A;Ostromecki, A;Conly, JM
一项针对重症监护病房患者的多中心前瞻性、随机、对照试验，使用0.5%氯己烯酊剂与10%聚维酮碘作为中心静脉导管（CVC）插入的皮肤防腐剂。在374名患者中，242名患者植入CVC长达30天，并用于初步分析。结果包括导管相关菌血症、显著的导管定植（大于或等于15个菌落形成单位[cfu]）、出位点感染、连续定量出位点培养（每72小时一次）和所有分离株的分子分型。两个研究组的患者在年龄、性别、潜在疾病、住院时间、线插入原因和基线APACHE II评分方面具有可比性。记录在案的导管相关菌血症率在氯己定组为4.6例/ 1000导管日（n = 125），聚维酮碘组为4.1例/ 1000导管日(n = 117；88例聚维酮碘组患者中24例（27%）和92例氯己定组患者中31例（34%）的导管末端有显著的定植，聚维酮碘组的平均出点菌落计数为5.9 X 10(5) cfu/mL / 25 cm(2)，氯己定组（NS）为3.1 X 10(5) cfu/mL / 25 cm(2)。氯己定组（125例患者中有0例）与聚维酮碘组（117例患者中有4例；P = 0.053）相比，有较少的出口部位感染的趋势。意向治疗分析的结果与主要分析的结果相同。0.5%氯己定酊剂和10%聚维酮碘用于重症监护病房患者CVC植入术的皮肤消毒无明显差异。
A multicenter prospective, randomized, controlled trial, with 0.5% tincture of chlorhexidene versus 10% povidone-iodine as cutaneous antisepsis for central venous catheter (CVC) insertion, was conducted for patients in intensive care units. Of 374 patients, 242 had a CVC inserted for >3 days and were used for the primary analysis. Outcomes included catheter-related bacteremia, significant catheter colonization (greater than or equal to 15 colony-forming units [cfu]), exit-site infection, serial quantitative exit-site culture (every 72 h), and molecular subtyping of all isolates. Patients in both study groups were comparable with respect to age, sex, underlying disease, length of hospitalization, reason for line insertion, and baseline APACHE II score. Documented catheter-related bacteremia rates were 4.6 cases per 1000 catheter-days in the chlorhexidine group (n = 125) and 4.1 cases per 1000 catheter-days in the povidone-iodine group (n = 117; not significant [NS]), Significant catheter-tip colonization occurred in 24 (27%) of 88 patients in the povidone-iodine group and in 31 (34%) of 92 patients in the chlorhexidine group (NS), A mean exit-site colony count of 5.9 X 10(5) cfu/mL per 25 cm(2) of the surface area of skin in the povidone-iodine group versus 3.1 X 10(5) cfu/mL per 25 cm(2) in the chlorhexidine group (NS) was found. There was a trend toward fewer exit-site infections in the chlorhexidine group (0 of 125 patients) versus those in the povidone-iodine group (4 of 117 patients; P = .053), Results of an intention-to-treat analysis were unchanged from the primary analysis. No difference was demonstrable between 0.5% tincture of chlorhexidine and 10% povidone-iodine when used for cutaneous antisepsis for CVC insertion in patients in the intensive care unit.