NEJM：每日氯己定洗浴可显著降低医院获得性感染的风险

既往单中心、观察性研究结果表明，患者每日用氯己定洗浴有可能预防医院获得性血液感染和耐多药微生物(MDROs)感染。氯己定（或称洗必泰）为外用抗菌剂及阳离子表面活性剂，对多数革兰氏阳性菌和革兰氏阴性菌具杀灭作用（虽然对革兰氏阴性菌作用较弱）。除可抑菌外，也可杀灭细菌。
美国弗吉尼亚州里士满市亨特·霍姆斯·麦奎尔退伍军人事务医学中心的Climo博士等人的研究显示，每日用氯己定浸渍过的毛巾洗浴可显著降低MDRO感染风险，并减少医院获得性血液感染的发生。研究成果发表于国际权威杂志NEJM 2013年5月最新一期在线版上。
研究人员进行了一项多中心、整群随机、非盲化的交叉试验，以评价每日用氯己定浸渍过的毛巾洗浴对MDRO感染和医院获得性血液感染发生率的影响。研究者对6家医院的9个重症监护治疗病房和骨髓移植单元进行了随机分组，第一组用免冲洗、2%氯己定浸渍过的毛巾对患者进行洗浴，第二组用不含抗菌剂毛巾对患者进行洗浴，为期6个月，在随后的6个月内交换替代产品。研究者采用Poisson回归分析对这2个时间段之间的MDRO感染率和医院获得性血液感染率进行了比较。
总计7727例患者被纳入该研究。结果显示，用氯己定浸渍过的毛巾组MDRO感染总发生率为5.10例/1000患者日（patient-days），与之相比，用不含抗菌剂毛巾组为6.60例/1000患者日（P=0.03），即相当于用氯己定洗浴后感染率降低了23%。用氯己定洗浴组医院获得性血液感染的总发生率为4.78例/1000患者日，相比之下，用不含抗菌剂毛巾为6.60例/1000患者日（P=0.007），使用氯己定浸渍过的毛巾后感染率降低28%。在任何一个研究时间段内，均未观察到严重的皮肤反应。
研究人员由此得出结论，每日用氯己定浸渍过的毛巾洗浴可显著降低MDRO感染风险，并减少医院获得性血液感染的发生。
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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.)