Effect of chlorhexidine bathing on colonization or infection with Acinetobacter baumannii: a systematic review and meta-analysis
Journal
Journal of Hospital Infection
Journal Volume
103
Journal Issue
3
Pages
284
Date Issued
2019-11-01
Author(s)
WANG-TSO LEE
Hsu, T. C.
Lee, C. H.
SHIH-PE WANG
Chen, W. S.
Abstract
© 2019 The Healthcare Infection Society Healthcare-associated infections (HAIs) caused by multi-drug-resistant Gram-negative bacteria (MDRGNB) have increased prevalence in intensive care units (ICUs). A common strategy to prevent HAIs is bathing patients with chlorhexidine gluconate (CHG). However, the effectiveness of CHG bathing against multidrug-resistant Acinetobacter baumannii (MDRAB) is still controversial. The aim of this study was to perform a systematic review and meta-analysis of the effectiveness of CHG bathing on Acinetobacter baumannii colonization and infection in the ICU setting. A systematic literature search of PubMed, EMBASE, Web of Science and CINAHL was performed from inception through to June 2018. Randomized controlled trials (RCTs), pre-post studies, or interrupted time series (ITS) studies were included. The numbers of patients with/without colonization or infection of A. baumannii in the experimental or control groups were extracted from each study. Quality assessment was performed by the related instruments of National Institute of Health. Pooled risk ratios (RRs) were calculated using the random-effects model. One RCT and 12 pre-post or ITS studies comprising 18,217 patients were included, of which 8069 were in the CHG bathing arm and 9051 in the control arm. CHG bathing was associated with a reduced colonization of A. baumannii (RR, 0.66; 95% confidence interval: 0.57–0.77; P<0.001). Chlorhexidine at 4% showed a better effect than 2% chlorhexidine (meta-regression P=0.044). CHG bathing was associated with a non-significant reduction of infection (pooled RR 0.41, 95% CI: 0.13–1.25). This study suggests that CHG bathing significantly reduces colonization of A. baumannii in the ICU setting. However, more trials are needed to confirm whether CHG bathing can reduce infections with A. baumannii.
Subjects
Chlorhexidine | Drug-resistant Acinetobacter baumannii | Short-course therapy | Treatment duration
Chlorhexidine; Drug-resistant Acinetobacter baumannii; Short-course therapy; Treatment duration
SDGs
Other Subjects
chlorhexidine; chlorhexidine; disinfectant agent; Acinetobacter infection; bacterial colonization; balneotherapy; clinical effectiveness; human; infection rate; infection risk; intensive care unit; meta analysis; national health organization; nonhuman; outcome assessment; randomized controlled trial (topic); Review; risk reduction; systematic review; Acinetobacter baumannii; Acinetobacter infection; adult; aged; bath; female; heterozygote; isolation and purification; male; middle aged; prevention and control; procedures; treatment outcome; very elderly; Acinetobacter baumannii; Acinetobacter Infections; Adult; Aged; Aged, 80 and over; Baths; Carrier State; Chlorhexidine; Disinfectants; Female; Humans; Intensive Care Units; Male; Middle Aged; Treatment Outcome
Publisher
W B SAUNDERS CO LTD
Type
journal article