NEJM:骨髓移植后洗必泰浸渍浴巾减少感染
2013-02-17 NEJM 医学论坛网 小康
美国一项研究表明,接受骨髓移植的患者入住IUC期间每天洗澡用洗必泰浸渍浴巾可显著降低被检出多药耐药菌和发生医院获得性血流感染的风险。论文2月7日发表于《新英格兰医学杂志》[N Engl J Med 2013,368(6):533-542]。 Effect of Daily Chlorhexidine Bathing on Hospital-Acquir
美国一项研究表明,接受骨髓移植的患者入住IUC期间每天洗澡用洗必泰浸渍浴巾可显著降低被检出多药耐药菌和发生医院获得性血流感染的风险。论文2月7日发表于《新英格兰医学杂志》[N Engl J Med 2013,368(6):533-542]。
Effect of Daily Chlorhexidine Bathing on Hospital-Acquired Infection
BACKGROUND
Results of previous single-center, observational studies suggest that daily bathing of patients with chlorhexidine may prevent hospital-acquired bloodstream infections and the acquisition of multidrug-resistant organisms (MDROs).
METHODS
We conducted a multicenter, cluster-randomized, nonblinded crossover trial to evaluate the effect of daily bathing with chlorhexidine-impregnated washcloths on the acquisition of MDROs and the incidence of hospital-acquired bloodstream infections. Nine intensive care and bone marrow transplantation units in six hospitals were randomly assigned to bathe patients either with no-rinse 2% chlorhexidine–impregnated washcloths or with nonantimicrobial washcloths for a 6-month period, exchanged for the alternate product during the subsequent 6 months. The incidence rates of acquisition of MDROs and the rates of hospital-acquired bloodstream infections were compared between the two periods by means of Poisson regression analysis.
RESULTS
A total of 7727 patients were enrolled during the study. The overall rate of MDRO acquisition was 5.10 cases per 1000 patient-days with chlorhexidine bathing versus 6.60 cases per 1000 patient-days with nonantimicrobial washcloths (P=0.03), the equivalent of a 23% lower rate with chlorhexidine bathing. The overall rate of hospital-acquired bloodstream infections was 4.78 cases per 1000 patient-days with chlorhexidine bathing versus 6.60 cases per 1000 patient-days with nonantimicrobial washcloths (P=0.007), a 28% lower rate with chlorhexidine-impregnated washcloths. No serious skin reactions were noted during either study period.
CONCLUSIONS
Daily bathing with chlorhexidine-impregnated washcloths significantly reduced the risks of acquisition of MDROs and development of hospital-acquired bloodstream infections. (Funded by the Centers for Disease Control and Prevention and Sage Products; ClinicalTrials.gov number, NCT00502476.)
作者:NEJM
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