Yun Kyung Chung1, Jae-Seok Kim2, Seung Soon Lee3, Jeong-A Lee4, Han-Sung Kim5, Kyong-Sok Shin6, Eun Young Park2, Bog Soun Kang7, Hee Jung Lee7, Hyun Joo Kang8. 1. Department of Occupational and Environmental Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea. 2. Department of Laboratory Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea. 3. Division of Infectious Diseases, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea. Electronic address: hushh93@hallym.or.kr. 4. Division of Infectious Diseases, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea. 5. Department of Laboratory Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea. 6. Department of Occupational and Environmental Medicine, Seegene Medical Foundation, Seoul, South Korea. 7. Medical Intensive Care Unit, Hallym University Sacred Heart Hospital, Anyang, South Korea. 8. Department of Infection Control, Hallym University Sacred Heart Hospital, Anyang, South Korea.
Abstract
BACKGROUND: There is insufficient evidence for daily chlorhexidine bathing to reduce nosocomial spread of carbapenem-resistant Acinetobacter baumannii (CRAB) in endemic situations. METHODS: An interrupted time series study was performed to evaluate the effect of daily chlorhexidine bathing on the acquisition of CRAB in a medical intensive care unit (ICU) with CRAB endemicity. There was a 14-month control period and 12-month chlorhexidine bathing period. Segmented Poisson regression analysis was performed to assess the impact of chlorhexidine bathing on the level and trend of the series of prevalence rates and incidence density. Also, chlorhexidine susceptibility testing was performed on CRAB isolates collected during the chlorhexidine bathing period. RESULTS: There was a 51.8% reduction of CRAB acquisition rates after an introduction of daily chlorhexidine bathing (44.0 vs 21.2 cases/1,000 at-risk patient days, P < .001). There was a significant reduction in the level (-0.604; 95% CI, -0.904 to -0.305; P < .001) of incidence density of CRAB, whereas there was no significant change in both level and trend of CRAB prevalence rates. Minimum inhibitory concentration of chlorhexidine against a total of 98 CRAB isolates ranged from 8-64 μg/mL. CONCLUSION: Daily chlorhexidine bathing significantly reduces the acquisition of CRAB in a medical ICU with CRAB endemicity.
BACKGROUND: There is insufficient evidence for daily chlorhexidine bathing to reduce nosocomial spread of carbapenem-resistant Acinetobacter baumannii (CRAB) in endemic situations. METHODS: An interrupted time series study was performed to evaluate the effect of daily chlorhexidine bathing on the acquisition of CRAB in a medical intensive care unit (ICU) with CRAB endemicity. There was a 14-month control period and 12-month chlorhexidine bathing period. Segmented Poisson regression analysis was performed to assess the impact of chlorhexidine bathing on the level and trend of the series of prevalence rates and incidence density. Also, chlorhexidine susceptibility testing was performed on CRAB isolates collected during the chlorhexidine bathing period. RESULTS: There was a 51.8% reduction of CRAB acquisition rates after an introduction of daily chlorhexidine bathing (44.0 vs 21.2 cases/1,000 at-risk patient days, P < .001). There was a significant reduction in the level (-0.604; 95% CI, -0.904 to -0.305; P < .001) of incidence density of CRAB, whereas there was no significant change in both level and trend of CRAB prevalence rates. Minimum inhibitory concentration of chlorhexidine against a total of 98 CRAB isolates ranged from 8-64 μg/mL. CONCLUSION: Daily chlorhexidine bathing significantly reduces the acquisition of CRAB in a medical ICU with CRAB endemicity.
Authors: Ruth A Reitzel; Joel Rosenblatt; Bahgat Z Gerges; Andrew Jarjour; Ana Fernández-Cruz; Issam I Raad Journal: JAC Antimicrob Resist Date: 2020-02-21