The effect of daily bathing with chlorhexidine on the acquisition of methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and healthcare-associated bloodstream infections: Results of a quasi-experimental multicenter trial
The effect of daily bathing with chlorhexidine on the acquisition of methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and healthcare-associated bloodstream infections: Results of a quasi-experimental multicenter trial
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DOI：
10.1097/ccm.0b013e31819ffe6d
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发表时间：
2009-06-01
影响因子：
8.8
通讯作者：
Wong, Edward S.
中科院分区：
文献类型：
--
作者：
Climo, Michael W.;Sepkowitz, Kent A.;Wong, Edward S.
目的：多重耐药微生物在重症监护病房 (ICU) 内的传播导致大量发病率和死亡率。需要新的策略来减少传播。本研究旨在确定每天使用洗必泰沐浴是否会降低 ICU 患者中因耐甲氧西林金黄色葡萄球菌 (MRSA) 和耐万古霉素肠球菌 (VRE) 引起的定植和血流感染 (BSI) 的发生率。 设计、环境和患者：四个学术中心的 6 个 ICU 测量了使用常规肥皂沐浴 6 个月期间 MRSA 和 VRE 定植和 BSI 的发生率，然后将结果与 6 个月期间的结果进行了比较，所有入院患者每天都接受氯己定溶液洗澡。通过泊松和分段回归模型评估发病率的变化。干预措施。每天用含洗必泰的溶液洗澡。测量和主要结果：每日使用洗必泰后，MRSA 的获得率下降了 32%（5.04 例与 3.44 例/1000 患者日，p = 0.046），VRE 的获得率下降了 50%（4.35 例与 2.19 例/1000 例患者日，p = 0.008）洗澡。分段回归分析表明，采用氯己定沐浴后，VRE 菌血症显着减少 (p = 0.02)。用洗必泰沐浴的 VRE 定植患者发生 VRE 菌血症的风险较低（相对风险 3.35；95% 置信区间 1.13-937；p = 0.035），表明定植水平的降低导致观察到的 BSI 减少。结论：我们得出结论，ICU 患者每天洗必泰沐浴可能会减少 MRSA 和 VRE 的感染。该方法实施简单且成本低廉，可能是屏障预防措施的重要辅助干预措施，以减少 VRE 和 MRSA 的感染以及随后与医疗保健相关的 BSI 的发展（Crit Care Med 2009；37：1858-1865）
Objective: Spread of multidrug-resistant organisms within the intensive rare unit (ICU) results in substantial morbidity and mortality. Novel strategies are needed to reduce transmission. This study sought to determine if the use of daily chlorhexidine bathing would decrease the incidence of colonization and bloodstream infections (BSI) because of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) among ICU patents.Design, Setting, and Patients: Six ICUs at four academic centers measured the incidence of MRSA and VRE colonization and BSI during a period of bathing with routine soap for 6 months and then compared results with a 6-month period where all admitted patients received daily bathing with a chlorhexidine solution. Changes in incidence were evaluated by Poisson and segmented regression modeling.Interventions. Daily bathing with a chlorhexidine-containing solution.Measurements and Main Results: Acquisition of MRSA decreased 32%(5.04 vs. 3.44 cases/1000 patient days, p = 0.046) and acquisition of VREdecreased 50% (4.35 vs. 2.19 cases/1000 patient days, p = 0.008) following the introduction of daily chlorhexidine bathing. Segmented regression analysis demonstrated significant reductions in VRE bacteremia (p = 0.02) following the introduction of chlorhexidine bathing. VRE-colonized patents bathed with chlorhexidine had a lower risk of developing VRE bacteremia (relative risk 3.35; 95% confidence interval 1.13-937; p = 0.035), suggesting that reductions in the level of colonization led to the observed reductions in BSI.Conclusion: We conclude that daily chlorhexidine bathing among ICU patients may reduce the acquisition of MRSA and VRE. The approach is simple to implement and inexpensive and may be an important adjunctive intervention to barrier precautions to reduce acquisition of VRE and MRSA and the subsequent development of healthcare-associated BSI (Crit Care Med 2009; 37:1858-1865)