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Chlorhexidine bathing for the prevention of colonization and infection with multidrug-resistant microorganisms in a hematopoietic stem cell transplantation unit over a 9-year period

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ABSTRACT

Health care associated infections (HAIs) are currently among the major challenges to the care of hematopoietic stem cell transplantation (HSCT) patients. The objective of the present study was to evaluate the impact of 2% chlorhexidine (CHG) bathing on the incidence of colonization and infection with vancomycin-resistant Enterococcus (VRE), multidrug-resistant (MDR) gram-negative pathogens, and to evaluate their CHG minimum inhibitory concentration (MIC) after the intervention.

A quasi-experimental study with duration of 9 years was conducted. VRE colonization and infection, HAI rates, and MDR gram-negative infection were evaluated by interrupted time series analysis. The antibacterial susceptibility profile and mechanism of resistance to CHG were analyzed in both periods by the agar dilution method in the presence or absence of the efflux pump inhibitor carbonyl cyanide-m-chlorophenyl hydrazone (CCCP) and presence of efflux pumps (qacA/E, qacA, qacE, cepA, AdeA, AdeB, and AdeC) by polymerase chain reaction (PCR).

The VRE colonization and infection rates were significantly reduced in the postintervention period (P = 0.001). However, gram-negative MDR rates in the unit increased in the last years of the study. The CHG MICs for VRE increased during the period of exposure to the antiseptic. A higher MIC at baseline period was observed in MDR gram-negative strains. The emergence of a monoclonal Pseudomonas aeruginosa clone was observed in the second period.

Concluding, CHG bathing was efficient regarding VRE colonization and infection, whereas no similar results were found with MDR gram-negative bacteria.

No MeSH data available.


Related in: MedlinePlus

Bianual incidence density of MDR infection and colonization in pre- and postintervention periods, in BMT unit, HC-FMUSP, 2005–2013. Col = colonization, GN = gram-negative bacteria, ID = Incidence density, Inf = Infection, MDR = Multidrug-resistant bacteria, VRE = Vancomycin-resistent Enterococcus.
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Figure 1: Bianual incidence density of MDR infection and colonization in pre- and postintervention periods, in BMT unit, HC-FMUSP, 2005–2013. Col = colonization, GN = gram-negative bacteria, ID = Incidence density, Inf = Infection, MDR = Multidrug-resistant bacteria, VRE = Vancomycin-resistent Enterococcus.

Mentions: The biannual distribution of infection rates of MDR microorganisms is shown in Fig. 1. The increased infection rates of MDR gram-negative bacteria are mainly due to an outbreak of P aeruginosa BSIs that occurred from December 2011 to January 2013. During this outbreak, 29 cases of P aeruginosa bacteraemia were recorded, especially within the first days after HSCT,[30] with 65% mortality.


Chlorhexidine bathing for the prevention of colonization and infection with multidrug-resistant microorganisms in a hematopoietic stem cell transplantation unit over a 9-year period
Bianual incidence density of MDR infection and colonization in pre- and postintervention periods, in BMT unit, HC-FMUSP, 2005–2013. Col = colonization, GN = gram-negative bacteria, ID = Incidence density, Inf = Infection, MDR = Multidrug-resistant bacteria, VRE = Vancomycin-resistent Enterococcus.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5120907&req=5

Figure 1: Bianual incidence density of MDR infection and colonization in pre- and postintervention periods, in BMT unit, HC-FMUSP, 2005–2013. Col = colonization, GN = gram-negative bacteria, ID = Incidence density, Inf = Infection, MDR = Multidrug-resistant bacteria, VRE = Vancomycin-resistent Enterococcus.
Mentions: The biannual distribution of infection rates of MDR microorganisms is shown in Fig. 1. The increased infection rates of MDR gram-negative bacteria are mainly due to an outbreak of P aeruginosa BSIs that occurred from December 2011 to January 2013. During this outbreak, 29 cases of P aeruginosa bacteraemia were recorded, especially within the first days after HSCT,[30] with 65% mortality.

View Article: PubMed Central - PubMed

ABSTRACT

Health care associated infections (HAIs) are currently among the major challenges to the care of hematopoietic stem cell transplantation (HSCT) patients. The objective of the present study was to evaluate the impact of 2% chlorhexidine (CHG) bathing on the incidence of colonization and infection with vancomycin-resistant Enterococcus (VRE), multidrug-resistant (MDR) gram-negative pathogens, and to evaluate their CHG minimum inhibitory concentration (MIC) after the intervention.

A quasi-experimental study with duration of 9 years was conducted. VRE colonization and infection, HAI rates, and MDR gram-negative infection were evaluated by interrupted time series analysis. The antibacterial susceptibility profile and mechanism of resistance to CHG were analyzed in both periods by the agar dilution method in the presence or absence of the efflux pump inhibitor carbonyl cyanide-m-chlorophenyl hydrazone (CCCP) and presence of efflux pumps (qacA/E, qacA, qacE, cepA, AdeA, AdeB, and AdeC) by polymerase chain reaction (PCR).

The VRE colonization and infection rates were significantly reduced in the postintervention period (P = 0.001). However, gram-negative MDR rates in the unit increased in the last years of the study. The CHG MICs for VRE increased during the period of exposure to the antiseptic. A higher MIC at baseline period was observed in MDR gram-negative strains. The emergence of a monoclonal Pseudomonas aeruginosa clone was observed in the second period.

Concluding, CHG bathing was efficient regarding VRE colonization and infection, whereas no similar results were found with MDR gram-negative bacteria.

No MeSH data available.


Related in: MedlinePlus