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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

Methicillin resistant S. aureus isolated from 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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Fig4: Methicillin resistant S. aureus isolated from 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: Four of the five trials in this meta-analysis reported the isolation of Gram-positive pathogens. Overall BSIs caused by Gram-positive pathogens involved 251 events in 132,678 patient-days with chlorhexidine compared to 351 events for 119,600 patient-days in the controls. Figure 3 summarizes the Gram-positive pathogens isolated. The summary effect of Gram-positive pathogens had a pooled RR of 0.59 (95 % CI 0.44–0.79; P < 0.001; I2 = 46.0 %) in a random-effects model. Subgroup analysis yielded more homogeneous results for Gram-positive pathogen-related BSIs. Subgroup analysis of mupirocin use in conjunction with chlorhexidine bathing yielded a pooled RR of 0.69 (95 % CI 0.57–0.83; P = 0.001; I2 = 21.6 %). There were significantly fewer MRSA-related BSIs with chlorhexidine than in the controls (pooled RR 0.64; 95 % CI 0.47–0.88; P = 0.006; I2 = 0.0 %; Fig. 4). In subgroup analysis by mupirocin use, MRSA-related BSIs were significantly fewer in the group featuring concomitant use of intranasal mupirocin and chlorhexidine bathing the chlorhexidine bathing compared to chlorhexidine bathing alone (pooled RR 0.63; 95 % CI 0.44–0.91; P = 0.013; I2 = 30.0 %).Fig. 3


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)

Methicillin resistant S. aureus isolated from 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

Fig4: Methicillin resistant S. aureus isolated from 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: Four of the five trials in this meta-analysis reported the isolation of Gram-positive pathogens. Overall BSIs caused by Gram-positive pathogens involved 251 events in 132,678 patient-days with chlorhexidine compared to 351 events for 119,600 patient-days in the controls. Figure 3 summarizes the Gram-positive pathogens isolated. The summary effect of Gram-positive pathogens had a pooled RR of 0.59 (95 % CI 0.44–0.79; P < 0.001; I2 = 46.0 %) in a random-effects model. Subgroup analysis yielded more homogeneous results for Gram-positive pathogen-related BSIs. Subgroup analysis of mupirocin use in conjunction with chlorhexidine bathing yielded a pooled RR of 0.69 (95 % CI 0.57–0.83; P = 0.001; I2 = 21.6 %). There were significantly fewer MRSA-related BSIs with chlorhexidine than in the controls (pooled RR 0.64; 95 % CI 0.47–0.88; P = 0.006; I2 = 0.0 %; Fig. 4). In subgroup analysis by mupirocin use, MRSA-related BSIs were significantly fewer in the group featuring concomitant use of intranasal mupirocin and chlorhexidine bathing the chlorhexidine bathing compared to chlorhexidine bathing alone (pooled RR 0.63; 95 % CI 0.44–0.91; P = 0.013; I2 = 30.0 %).Fig. 3

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