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干预措施以预防感染是卫生与公众服务部及其运作部门（NIH， AHRQ和CDC）的优先事项。中心静脉相关血流感染（CLABSI）和多药耐药生物感染（MDRO）是最常见的医疗保健相关感染，在医疗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）沐浴已被证明可以降低危重成人CLABSI的发生率和MDRO（定植和感染）的获得。目前尚不清楚小儿肿瘤患者是否也能获得同样的益处。由于这些感染具有潜在的破坏性，因此迫切需要对该人群进行研究，血流感染的发病机制可能在该人群中有所不同，并且对皮肤完整性的关注也有所增加。本提案的主要目标是确定CHG沐浴是否降低癌症儿童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研究降低对CHG的易感性。重要的是监测和了解对抗菌素和防腐剂干预措施的耐药性的影响。在CHG的例子中，有

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.