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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

The overall incidence of hospital-acquired bloodstream infections. Each effect size is shown with its confidence interval (CI) as solid triangle. The overall effect and CI are shown as a diamond with a dotted line indicating its location. Vertical solid line at 1 indicates no treatment effect. M–H Mantel–Haenszel weighted fixed effects, D + L random-effects estimate
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Fig2: The overall incidence of hospital-acquired bloodstream infections. Each effect size is shown with its confidence interval (CI) as solid triangle. The overall effect and CI are shown as a diamond with a dotted line indicating its location. Vertical solid line at 1 indicates no treatment effect. M–H Mantel–Haenszel weighted fixed effects, D + L random-effects estimate

Mentions: The primary outcome was the overall incidence of measured hospital-acquired BSI; 587 BSI events developed in the chlorhexidine group over 151,879 patient-days, compared to 670 in the control arm over 140,320 patient-days. Fixed-effects modeling yielded an RR of 0.82 (95 % CI 0.73–0.91; P < 0.001; I2 = 20.6 %). Figure 2 summarizes the primary outcome.Fig. 2


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)

The overall incidence of hospital-acquired bloodstream infections. Each effect size is shown with its confidence interval (CI) as solid triangle. The overall effect and CI are shown as a diamond with a dotted line indicating its location. Vertical solid line at 1 indicates no treatment effect. M–H Mantel–Haenszel weighted fixed effects, D + L random-effects estimate
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig2: The overall incidence of hospital-acquired bloodstream infections. Each effect size is shown with its confidence interval (CI) as solid triangle. The overall effect and CI are shown as a diamond with a dotted line indicating its location. Vertical solid line at 1 indicates no treatment effect. M–H Mantel–Haenszel weighted fixed effects, D + L random-effects estimate
Mentions: The primary outcome was the overall incidence of measured hospital-acquired BSI; 587 BSI events developed in the chlorhexidine group over 151,879 patient-days, compared to 670 in the control arm over 140,320 patient-days. Fixed-effects modeling yielded an RR of 0.82 (95 % CI 0.73–0.91; P < 0.001; I2 = 20.6 %). Figure 2 summarizes the primary outcome.Fig. 2

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