Chlorhexidine for the prevention of bloodstream infection associated with totally implantable venous ports in patients with solid cancers
Journal
Supportive Care in Cancer
Journal Volume
22
Journal Issue
5
Pages
1189-1197
Date Issued
2014
Author(s)
I. Chen
Chang S.-Y.
Chien S.-F.
Hu F.-C.
Abstract
Purpose: To evaluate the preventive effects of topical skin disinfection with chlorhexidine on bloodstream infection (BSI) associated with totally implantable venous port (Port-A). Methods: Two consecutive cohorts of solid cancer patients were prospectively followed for the occurrence of Port-A associated BSI (PABSI). The first cohort used povidone-iodine as topical skin disinfection and the second cohort used chlorhexidine. The primary endpoint was the time to first PABSI. Propensity score analysis was applied. The preventive effects of chlorhexidine were analyzed by Cox proportional hazards models. Results: There were 396 patients (81,752 catheter-days) in the iodine cohort and 497 (99,977 catheter-days) in the chlorhexidine cohort. Gram-negative bacteria were the most common pathogens to cause first episode of PABSI (iodine cohort (I) vs chlorhexidine cohort (C) and 0.404 vs 0.450 per 1,000 catheter-day), followed by Gram-positive bacteria (I vs C and 0.269 vs 0.110 per 1,000 catheter-day), and fungi (I vs C and 0.098 vs 0.070 per 1,000 catheter-day). Three hundred forty-three patients were selected from each cohort by propensity score match analysis. Chlorhexidine use was associated with a significant improvement on time to first PABSI caused by Gram-positive bacteria (log-rank test, p=0.00175; HR=0.35, 95 % CI, 0.14-0.85, p=0.02). No significant preventive effects of chlorhexidine on time to first PABSI caused by Gram-negative bacteria or fungi was found. Conclusions: Chlorhexidine topical skin disinfection may prevent PABSI caused by Gram-positive bacteria in patients with solid cancers. The nonsignificant effect on preventing overall PABSI may be attributed to the high incidence of Gram-negative bacteria related PABSI. ? 2014 Springer-Verlag.
SDGs
Other Subjects
antineoplastic agent; chlorhexidine; povidone iodine; adolescent; adult; aged; antibiotic prophylaxis; antibiotic therapy; article; bloodstream infection; breast cancer; cancer chemotherapy; catheter infection; central venous catheter; cohort analysis; controlled study; digestive system cancer; female; follow up; Gram negative bacterium; Gram positive bacterium; human; incidence; infection prevention; infection risk; lung cancer; major clinical study; male; neutropenia; overall survival; pathogenesis; port a associated bloodstream infection; postoperative care; priority journal; prospective study; risk factor; skin decontamination; solid tumor; topical treatment; Adolescent; Adult; Aged; Anti-Infective Agents, Local; Bacteremia; Catheter-Related Infections; Catheterization, Central Venous; Catheters, Indwelling; Chlorhexidine; Cohort Studies; Female; Humans; Male; Middle Aged; Neoplasms; Povidone-Iodine; Young Adult
Publisher
Springer Verlag
Type
journal article