Impact of chlorhexidine bathing on reducing infections in children with cancer

描述（由申请人提供）：提高对卫生保健相关感染的理解并制定预防感染的干预措施是卫生与公众服务部及其业务部门的高度优先事项：NIH，AHRQ和CDC。中心静脉导管相关血流感染（CLABSI）和多重耐药微生物（MDRO）引起的感染是最常见的医疗保健相关感染，在医疗保健资源支出和患者发病率和死亡率方面成本最高。葡萄糖酸氯己定（CHG）沐浴已被证明可降低危重成人CLABSI和MDRO（定植和感染）的发生率。目前尚不清楚是否可以在儿科肿瘤患者中预期相同的获益。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不同，并且对皮肤完整性的关注度更高。本提案的主要目的是确定CHG沐浴是否降低癌症儿童CLABSI的发生率和获得流行病学重要的MDRO。次要目标是在临床背景下研究对CHG的敏感性降低。重要的是要监测和了解抗微生物和防腐剂干预耐药性的影响。就CHG而言，有 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的耐药性，并且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尚不确定。有三个具体目标：目标1。确定CHG沐浴是否降低癌症儿童CLABSI的发生率。 目标2.确定CHG沐浴是否减少癌症儿童中流行病学重要MDRO的新获得（定植或感染）。 目标3。确定癌症儿童CHG沐浴是否与皮肤细菌分离株对CHG敏感性降低相关。战略我们提出了一项随机，双盲，对照试验CHG沐浴在儿童癌症与儿童肿瘤组和12个经验丰富的儿童肿瘤组中心，致力于这项研究的成功合作。本案无关本研究的结果将确定CHG沐浴在降低高危儿科肿瘤患者的CLABSI和MDRO获得方面的作用。这些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敏感性降低以及CHG敏感性与常用抗生素耐药性之间关系的新数据。这些数据可能有利于未来的CHG沐浴接受者。

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.