Impact of chlorhexidine bathing on reducing infections in children with cancer

描述(由申请人提供)：提高对医疗保健相关感染的了解并制定预防措施是卫生与公众服务部及其业务部门(NIH、AHRQ和CDC)的高度优先事项。中心线相关血流感染(CLABSI)和多药耐药菌(MDRO)感染是最常见的医疗相关感染，也是医疗资源支出和患者发病率和死亡率最高的感染。已有研究表明，洗澡可减少危重成人CLABSI和MDRO(定植和感染)的发生率。目前尚不清楚儿科肿瘤患者是否也能获得同样的益处。迫切需要在这一人群中进行研究，因为这些感染具有潜在的破坏性，血液感染的发病机制在这一人群中可能是不同的，而且人们对皮肤完整性的担忧也越来越高。这项建议的主要目标是确定CHG沐浴是否能减少癌症儿童CLABSI的发生率和流行病学上重要的MDRO的获得。第二个目标是在临床背景下调查CHG的易感性降低。重要的是要监测和了解抗菌剂和防腐剂抗药性干预措施的影响。在CHG的情况下， 有限的横断面和体外数据表明，暴露于CHG可能会诱导细菌对CHG产生耐药性，这种耐药性可能与对常用抗生素的耐药性有关。然而，这些数据的临床适用性还不确定。目的1.确定CHG沐浴是否能降低癌症儿童CLABSI的发生率。目的2.确定CHG洗澡是否能减少癌症儿童新感染的、具有重要流行病学意义的MDRO。目的3.确定癌症儿童沐浴CHG是否与对CHG敏感性降低的皮肤细菌分离有关。战略。我们建议与致力于这项研究成功的儿童肿瘤学小组和12个经验丰富的儿童肿瘤小组中心合作，进行一项随机、双盲、对照的CHG沐浴试验。关联性。这项研究的结果将确定CHG沐浴在降低高危儿童肿瘤患者的CLABSI和MDRO获得方面的效果。这样的结果有可能影响这些儿童的临床护理和结果。这项研究还将提供有关CHG敏感性降低的新数据，以及CHG敏感性与常用抗生素耐药性之间的关系。这些数据可能会让未来接受CHG洗澡的人受益。 公共卫生相关性：我们建议研究用常见的杀菌剂葡萄糖酸氯己定(CHG)洗澡在减少癌症儿童中心线相关性血流感染和获得多药耐药微生物方面的效果。这些感染是该人群发病和死亡的重要原因。这项研究的结果有可能改善癌症儿童的临床护理和预后。

DESCRIPTION (provided by applicant): Improving the understanding of healthcare-associated infections and developing interventions to prevent them are high priorities for the Department of Health and Human Services and its operating divisions: the NIH, the AHRQ, and the CDC. Central line-associated bloodstream infections (CLABSI) and infections due to multi-drug resistant organisms (MDRO) are among the most common healthcare-associated infections, and the most costly in terms of expenditure of healthcare resources and patient morbidity and mortality. Chlorhexidine gluconate (CHG) bathing has been shown to reduce the incidence of CLABSI and acquisition of MDRO (colonization and infection) in critically ill adults. It is unknown whether the same benefit can be expected in pediatric oncology patients. Studies in this population are urgently needed as these infections are potentially devastating, the pathogenesis of bloodstream infections may be different in this population, and there is heightened concern about skin integrity. The primary goal of this proposal is to determine whether CHG bathing reduces the incidence of CLABSI and acquisition of epidemiologically important MDRO in children with cancer. The secondary goal is to investigate reduced susceptibility to CHG in a clinical context. It is important to monitor for and understand the implications of resistance to antimicrobial and antiseptic interventions. In the case of CHG, there are limited cross-sectional and in vitro data suggesting that exposure to CHG may induce CHG resistance in bacteria, and that this resistance may be associated with resistance to commonly-used antibiotics. However, the clinical applicability of these data is uncertain. There are 3 Specific Aims: Aim 1. To determine whether CHG bathing decreases the incidence of CLABSI in children with cancer. Aim 2. To determine whether CHG bathing decreases new acquisition (colonization or infection) of epidemiologically important MDRO in children with cancer. Aim 3. To determine whether CHG bathing in children with cancer is associated with cutaneous bacterial isolates with reduced susceptibility to CHG. Strategy. We propose a randomized, double-blind, controlled trial of CHG bathing in children with cancer in collaboration with the Children's Oncology Group and 12 experienced Children's Oncology Group centers that are committed to the success of this study. Relevance. Results from this study will determine the effect of CHG bathing in reducing CLABSI and acquisition of MDRO in high-risk pediatric oncology patients. Such results have the potential to impact the clinical care and outcomes of these children. This study will also provide novel data about reduced susceptibility to CHG and the relationship between CHG susceptibility and resistance to commonly used antibiotics. These data may benefit future recipients of CHG bathing. PUBLIC HEALTH RELEVANCE: We propose to study the effect that bathing with the common antiseptic chlorhexidine gluconate (CHG) has on reducing the incidence of central line-associated bloodstream infections and acquisition of multi-drug resistant organisms in children with cancer. These infections are important causes of morbidity and mortality in this population. Results from this study have the potential to improve the clinical care and outcomes of children with cancer.