Randomized Controlled Trial of Chlorhexidine Dressing and Highly Adhesive Dressing for Preventing Catheter-related Infections in Critically Ill Adults

被引：158

作者：

Timsit, Jean-Francois ^{[1
,2
]}

Mimoz, Olivier ^{[3
,4
]}

Mourvillier, Bruno ^{[5
]}

Souweine, Bertrand ^{[8
]}

Garrouste-Orgeas, Maite ^{[9
]}

Alfandari, Serge ^{[10
]}

Plantefeve, Gaetan ^{[11
]}

Bronchard, Regis ^{[6
]}

Troche, Gilles ^{[12
]}

Gauzit, Remy ^{[13
]}

Antona, Marion ^{[14
]}

Canet, Emmanuel ^{[15
]}

Bohe, Julien ^{[16
]}

Lepape, Alain ^{[16
]}

Vesin, Aurelien ^{[1
]}

Arrault, Xavier ^{[7
]}

Schwebel, Carole ^{[2
]}

Adrie, Christophe ^{[17
]}

Zahar, Jean-Ralph ^{[18
]}

Ruckly, Stephane ^{[1
]}

Tournegros, Caroline ^{[2
]}

Lucet, Jean-Christophe ^{[19
,20
]}

机构：

[1] Univ Grenoble 1, Outcome Canc & Crit Illness U823, Albert Bonniot Inst, F-38076 La Tronche, France

[2] Univ Grenoble 1, Med ICU, Albert Michallon Hosp, Grenoble, France

[3] Univ Poitiers, Serv Anesthesie Reanimat, Ctr Hosp Univ, Poitiers, France

[4] INSERM, U1070, Poitiers, France

[5] Bichat Claude Bernard Univ Hosp, Med ICU, Paris, France

[6] Bichat Claude Bernard Univ Hosp, Surg ICU, Paris, France

[7] Bichat Claude Bernard Univ Hosp, Drug Delivery Dept, Paris, France

[8] Univ Clermont Ferrand 2, Med ICU, Gabriel Montpied Hosp, Clermont Ferrand, France

[9] St Joseph Hosp Network, Med Surg ICU, Paris, France

[10] Gen Hosp, Intens Care & Infect Dis Unit, Tourcoing, France

[11] Gen Hosp, Med Surg ICU, Argenteuil, France

[12] Gen Hosp, Med Surg Intens Care Unit, Versailles, France

[13] Hotel Dieu Univ Hosp, Surg Intens Care Unit, Paris, France

[14] Univ Versailles SQY, Raymond Poincare Hosp, Gen ICU, Garches, France

[15] Univ Paris 07, Med ICU, St Louis Hosp, Paris, France

[16] Univ Lyon 1, Med Surg ICU, Ctr Hosp Lyon Sud, F-69365 Lyon, France

[17] Cochin Hosp, Dept Physiol, Paris, France

[18] Hop Necker Enfants Malad, Paris, France

[19] Bichat Claude Bernard Univ Hosp, Assistance Publ Hop Paris, Infect Control Unit, Sorbonne Paris Cite, France

[20] Univ Paris Diderot, Sorbonne Paris Cite, France

来源：

AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE | 2012年 / 186卷 / 12期

关键词：

vascular catheter; infection; prevention; chlorhexidine dressings; BLOOD-STREAM INFECTIONS; CARE; DIAGNOSIS; RISK; MICROBIOLOGY; COLONIZATION; BACTEREMIA; GUIDELINES; MANAGEMENT; ACCESS;

D O I：

10.1164/rccm.201206-1038OC

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Rationale: Most vascular catheter-related infections (CRIs) occur extra-luminally in patients in the intensive care unit (ICU). Chlorhexidine-impregnated and strongly adherent dressings may decrease catheter colonization and CRI rates. Objectives: To determine if chlorhexidine-impregnated and strongly adherent dressings decrease catheter colonization and CRI rates. Methods: In a 2:1:1 assessor-masked randomized trial in patients with vascular catheters inserted for an expected duration of 48 hours or more in 12 French ICUs, we compared chlorhexidine dressings, highly adhesive dressings, and standard dressings from May 2010 to July 2011. Coprimary endpoints were major CRI with or without catheter-related bloodstream infection (CR-BSI) with chlorhexidine versus nonchlorhexidine dressings and catheter colonization rate with highly adhesive nonchlorhexidine versus standard nonchlorhexidine dressings. Catheter-colonization, CR-BSIs, and skin reactions were secondary endpoints. Measurements and Main Results: A total of 1,879 patients (4,163 catheters and 34,339 catheter-days) were evaluated. With chlorhexidine dressings, the major-CRI rate was 67% lower (0.7 per 1,000 vs. 2.1 per 1,000 catheter-days; hazard ratio [HR], 0.328; 95% confidence interval [CI], 0.174-0.619; P = 0.0006) and the CR-BSI rate 60% lower (0.5 per 1,000 vs. 1.3 per 1,000 catheter-days; HR, 0.402; 95% Cl, 0.186-0.868; P = 0.02) than with nonchlorhexidine dressings; decreases were noted in catheter colonization and skin colonization rates at catheter removal. The contact dermatitis rate was 1.1% with and 0.29% without chlorhexidine. Highly adhesive dressings decreased the detachment rate to 64.3% versus 71.9% (P < 0.0001) and the number of dressings per catheter to two (one to four) versus three (one to five) (P < 0.0001) but increased skin colonization (P < 0.0001) and catheter colonization (HR, 1.650; 95% Cl, 1.21-2.26; P = 0.0016) without influencing CRI or CR-BSI rates. Conclusions: A large randomized trial demonstrated that chlorhexidine-gel-impregnated dressings decreased the CRI rate in patients in the ICU with intravascular catheters. Highly adhesive dressings decreased dressing detachment but increased skin and catheter colonization.

引用

页码：1272 / 1278

页数：7

共 31 条

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