Limits...
Efficacy of chlorhexidine bathing for reducing healthcare associated bloodstream infections: a meta-analysis.

Choi EY, Park DA, Kim HJ, Park J - Ann Intensive Care (2015)

Bottom Line: The incidence of MRSA bacteremias (RR 0.63; 95 % CI 0.44-0.91; P = 0.006; I (2) = 30.3 %) was significantly lower among patients who received mupirocin in addition to chlorhexidine bathing than among those who did not routinely receive mupirocin.Daily bathing with chlorhexidine may be effective to reduce the incidence of hospital-acquired BSIs.However, chlorhexidine bathing alone may be of limited utility in reduction of MRSA bacteremia; intranasal mupirocin may also be required.

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonary and Critical Care Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea. letact@hanmail.net.

ABSTRACT

Background: We performed a meta-analysis of randomized controlled trials (RCTs) to determine if daily bathing with chlorhexidine decreased hospital-acquired BSIs in critically ill patients.

Methods: We searched the MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases to identify randomized controlled trials that compared daily bathing with chlorhexidine and a control in critically ill patients.

Results: This meta-analysis included five RCTs. The overall incidence of measured hospital-acquired BSIs was significantly lower in the chlorhexidine group compared to the controls 0.69 (95 % CI 0.55-0.85; P < 0.001; I (2) = 57.7 %). Gram-positive-induced (RR = 0.49, 95 % CI 0.41-0.58; P = 0.000; I (2) = 0.0 %) bacteremias were significantly less common in the chlorhexidine group. The incidence of MRSA bacteremias (RR 0.63; 95 % CI 0.44-0.91; P = 0.006; I (2) = 30.3 %) was significantly lower among patients who received mupirocin in addition to chlorhexidine bathing than among those who did not routinely receive mupirocin.

Conclusions: Daily bathing with chlorhexidine may be effective to reduce the incidence of hospital-acquired BSIs. However, chlorhexidine bathing alone may be of limited utility in reduction of MRSA bacteremia; intranasal mupirocin may also be required. This meta-analysis has several limitations. Future large-scale international multicenter studies are needed.

No MeSH data available.


Related in: MedlinePlus

Flow-diagram of the selection criteria. Flow chart explaining the selection of eligible studies included in the meta-analysis
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4596146&req=5

Fig1: Flow-diagram of the selection criteria. Flow chart explaining the selection of eligible studies included in the meta-analysis

Mentions: The clinical outcomes in our analysis can be categorized as binary or continuous data. BSIs were quantified as patient-days. One patient-day represents a unit of time during which the services of the institution or facility are used by a patient. Relative risk (RR) and 95 % confidence interval (CI) were used as the summary effect for a binary outcome, and the standardized mean difference and 95 % CI were used as the summary effect of a continuous outcome. Data were pooled using the Mantel–Haenszel method. We reported results according to a fixed-effects model in the absence of significant heterogeneity, and to a random-effects model [17] in the presence of significant heterogeneity. We used the random-effects model because it accounts for variation among studies, in addition to sampling error within studies [16]. The appropriateness of pooling data across studies was assessed using Cochrane’s χ2 test and the I2 test for heterogeneity, which measure the inconsistency across the study results and describe the proportion of the total variation in the study estimates that is due to heterogeneity, rather than sampling error. Statistically significant heterogeneity was considered to be present when P < 0.10 and I2 > 50 % [18]. We checked the publication bias as subgroup analysis based on differences in design, type of control, the number of study sample, concomitant using drug, and so on. We followed the guidelines of the Cochrane Handbook for meta-analysis of randomized controlled studies, and PRISMA criteria were used to evaluate research methodology (Fig. 1). Two-sided P values less than 0.05 were considered statistically significant. Meta-analyses, forest plots, and publication bias analyses were produced using Stata SE 13.1 for Mac (Stata Corp, TX, USA) [19]. We pre-specified the subgroup analysis according to more similar interventions or control groups.Fig. 1


Efficacy of chlorhexidine bathing for reducing healthcare associated bloodstream infections: a meta-analysis.

Choi EY, Park DA, Kim HJ, Park J - Ann Intensive Care (2015)

Flow-diagram of the selection criteria. Flow chart explaining the selection of eligible studies included in the meta-analysis
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4596146&req=5

Fig1: Flow-diagram of the selection criteria. Flow chart explaining the selection of eligible studies included in the meta-analysis
Mentions: The clinical outcomes in our analysis can be categorized as binary or continuous data. BSIs were quantified as patient-days. One patient-day represents a unit of time during which the services of the institution or facility are used by a patient. Relative risk (RR) and 95 % confidence interval (CI) were used as the summary effect for a binary outcome, and the standardized mean difference and 95 % CI were used as the summary effect of a continuous outcome. Data were pooled using the Mantel–Haenszel method. We reported results according to a fixed-effects model in the absence of significant heterogeneity, and to a random-effects model [17] in the presence of significant heterogeneity. We used the random-effects model because it accounts for variation among studies, in addition to sampling error within studies [16]. The appropriateness of pooling data across studies was assessed using Cochrane’s χ2 test and the I2 test for heterogeneity, which measure the inconsistency across the study results and describe the proportion of the total variation in the study estimates that is due to heterogeneity, rather than sampling error. Statistically significant heterogeneity was considered to be present when P < 0.10 and I2 > 50 % [18]. We checked the publication bias as subgroup analysis based on differences in design, type of control, the number of study sample, concomitant using drug, and so on. We followed the guidelines of the Cochrane Handbook for meta-analysis of randomized controlled studies, and PRISMA criteria were used to evaluate research methodology (Fig. 1). Two-sided P values less than 0.05 were considered statistically significant. Meta-analyses, forest plots, and publication bias analyses were produced using Stata SE 13.1 for Mac (Stata Corp, TX, USA) [19]. We pre-specified the subgroup analysis according to more similar interventions or control groups.Fig. 1

Bottom Line: The incidence of MRSA bacteremias (RR 0.63; 95 % CI 0.44-0.91; P = 0.006; I (2) = 30.3 %) was significantly lower among patients who received mupirocin in addition to chlorhexidine bathing than among those who did not routinely receive mupirocin.Daily bathing with chlorhexidine may be effective to reduce the incidence of hospital-acquired BSIs.However, chlorhexidine bathing alone may be of limited utility in reduction of MRSA bacteremia; intranasal mupirocin may also be required.

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonary and Critical Care Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea. letact@hanmail.net.

ABSTRACT

Background: We performed a meta-analysis of randomized controlled trials (RCTs) to determine if daily bathing with chlorhexidine decreased hospital-acquired BSIs in critically ill patients.

Methods: We searched the MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases to identify randomized controlled trials that compared daily bathing with chlorhexidine and a control in critically ill patients.

Results: This meta-analysis included five RCTs. The overall incidence of measured hospital-acquired BSIs was significantly lower in the chlorhexidine group compared to the controls 0.69 (95 % CI 0.55-0.85; P < 0.001; I (2) = 57.7 %). Gram-positive-induced (RR = 0.49, 95 % CI 0.41-0.58; P = 0.000; I (2) = 0.0 %) bacteremias were significantly less common in the chlorhexidine group. The incidence of MRSA bacteremias (RR 0.63; 95 % CI 0.44-0.91; P = 0.006; I (2) = 30.3 %) was significantly lower among patients who received mupirocin in addition to chlorhexidine bathing than among those who did not routinely receive mupirocin.

Conclusions: Daily bathing with chlorhexidine may be effective to reduce the incidence of hospital-acquired BSIs. However, chlorhexidine bathing alone may be of limited utility in reduction of MRSA bacteremia; intranasal mupirocin may also be required. This meta-analysis has several limitations. Future large-scale international multicenter studies are needed.

No MeSH data available.


Related in: MedlinePlus