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Chlorhexidine body washing to control antimicrobial-resistant bacteria in intensive care units: a systematic review.

Derde LP, Dautzenberg MJ, Bonten MJ - Intensive Care Med (2012)

Bottom Line: Incidences of MRSA acquisition were reduced significantly in three studies in which this was the primary endpoint.There were hardly any data on the effects of CHG-BW on antibiotic-resistant gram-negative bacteria (ARGNB).As CHG-BW protocols, co-interventions and case mix varied widely, attribution of these effects to CHG-BW alone should be done with care.

View Article: PubMed Central - PubMed

Affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG Utrecht, The Netherlands. lderde@umcutrecht.nl

ABSTRACT

Purpose: Infections caused by antimicrobial-resistant bacteria (AMRB) are increasing worldwide, especially in intensive care units (ICUs). Chlorhexidine body washing (CHG-BW) has been proposed as a measure to limit the spread of AMRB. We have systematically assessed the evidence on the effectiveness of CHG-BW in reducing colonization and infection with AMRB in adult ICU patients.

Methods: PubMed, Embase, CINAHL, and OpenSigle databases were searched using synonyms for "intensive care unit," "hospital," and "chlorhexidine." All potentially relevant articles were examined by two independent reviewers. Inclusion was limited to studies with ICU patients as domain, providing outcomes related to colonization or infection with AMRB. Data from 16 studies were extracted; 9 were excluded because of assessed high risk of bias or inadequate analyses. The remaining studies differed markedly in (co-)interventions and case mix, which precluded pooling of data in a formal meta-analysis.

Results: Incidences of MRSA acquisition were reduced significantly in three studies in which this was the primary endpoint. Significant reduction in MRSA infection rates was observed in only one of five studies. Carriage and bacteremia rates of VRE were assessed in one study, and both significantly declined. There were hardly any data on the effects of CHG-BW on antibiotic-resistant gram-negative bacteria (ARGNB).

Conclusions: CHG-BW may be effective in preventing carriage, and possibly bloodstream infections, with MRSA and VRE in different ICU settings. As CHG-BW protocols, co-interventions and case mix varied widely, attribution of these effects to CHG-BW alone should be done with care. Evidence that CHG-BW reduces carriage of or infections with ARGNB is lacking.

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Related in: MedlinePlus

Study flow diagram
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Related In: Results  -  Collection


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Fig1: Study flow diagram

Mentions: None of the studies including hospital patients included results for ICU patients separately, nor could these results be calculated from the data presented. Therefore, we excluded these studies. The data collection flowchart is shown in Fig. 1.Fig. 1


Chlorhexidine body washing to control antimicrobial-resistant bacteria in intensive care units: a systematic review.

Derde LP, Dautzenberg MJ, Bonten MJ - Intensive Care Med (2012)

Study flow diagram
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3351589&req=5

Fig1: Study flow diagram
Mentions: None of the studies including hospital patients included results for ICU patients separately, nor could these results be calculated from the data presented. Therefore, we excluded these studies. The data collection flowchart is shown in Fig. 1.Fig. 1

Bottom Line: Incidences of MRSA acquisition were reduced significantly in three studies in which this was the primary endpoint.There were hardly any data on the effects of CHG-BW on antibiotic-resistant gram-negative bacteria (ARGNB).As CHG-BW protocols, co-interventions and case mix varied widely, attribution of these effects to CHG-BW alone should be done with care.

View Article: PubMed Central - PubMed

Affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG Utrecht, The Netherlands. lderde@umcutrecht.nl

ABSTRACT

Purpose: Infections caused by antimicrobial-resistant bacteria (AMRB) are increasing worldwide, especially in intensive care units (ICUs). Chlorhexidine body washing (CHG-BW) has been proposed as a measure to limit the spread of AMRB. We have systematically assessed the evidence on the effectiveness of CHG-BW in reducing colonization and infection with AMRB in adult ICU patients.

Methods: PubMed, Embase, CINAHL, and OpenSigle databases were searched using synonyms for "intensive care unit," "hospital," and "chlorhexidine." All potentially relevant articles were examined by two independent reviewers. Inclusion was limited to studies with ICU patients as domain, providing outcomes related to colonization or infection with AMRB. Data from 16 studies were extracted; 9 were excluded because of assessed high risk of bias or inadequate analyses. The remaining studies differed markedly in (co-)interventions and case mix, which precluded pooling of data in a formal meta-analysis.

Results: Incidences of MRSA acquisition were reduced significantly in three studies in which this was the primary endpoint. Significant reduction in MRSA infection rates was observed in only one of five studies. Carriage and bacteremia rates of VRE were assessed in one study, and both significantly declined. There were hardly any data on the effects of CHG-BW on antibiotic-resistant gram-negative bacteria (ARGNB).

Conclusions: CHG-BW may be effective in preventing carriage, and possibly bloodstream infections, with MRSA and VRE in different ICU settings. As CHG-BW protocols, co-interventions and case mix varied widely, attribution of these effects to CHG-BW alone should be done with care. Evidence that CHG-BW reduces carriage of or infections with ARGNB is lacking.

Show MeSH
Related in: MedlinePlus