Comparison of the efficacy of three topical antiseptic solutions for the prevention of catheter colonization: a multicenter randomized controlled study

被引：29

作者：

Yasuda, Hideto ^{[1
,2
,3
]}

Sanui, Masamitsu ^{[4
]}

Abe, Takayuki ^{[3
,5
]}

Shime, Nobuaki ^{[6
]}

Komuro, Tetsuya ^{[4
]}

Hatakeyama, Junji ^{[7
]}

Matsukubo, Shohei ^{[8
]}

Kawano, Shinji ^{[9
]}

Yamamoto, Hiroshi ^{[10
]}

Andoh, Kohkichi ^{[11
]}

Seo, Ryutaro ^{[12
]}

Inoue, Kyo ^{[13
]}

Noda, Eiichiro ^{[14
]}

Saito, Nobuyuki ^{[15
]}

Nogami, Satoshi ^{[16
]}

Okamoto, Kentaro ^{[17
]}

Fuke, Ryota ^{[18
]}

Gushima, Yasuhiro ^{[19
]}

Kobayashi, Atsuko ^{[20
]}

Takebayashi, Toru ^{[3
]}

Lefor, Alan Kawarai ^{[21
]}

机构：

[1] Japanese Red Cross Musashino Hosp, Dept Emergency & Crit Care Med, Intens Care Unit, 1-26-1,Kyounanchou, Musashino, Tokyo 1808610, Japan

[2] Kameda Gen Hosp, Dept Intens Care Unit, 929 Higashi Cho, Kamogawa City, Chiba 2968602, Japan

[3] Keio Univ, Sch Med, Dept Prevent Med & Publ Hlth, Shinjuku Ku, 35 Shinanomachi, Tokyo 1608582, Japan

[4] Jichi Med Univ, Saitama Med Ctr, Dept Anesthesiol & Crit Care Med, Omiya Ku, 1-847,Amanuma Cho, Saitama, Saitama 3308503, Japan

[5] Keio Univ Hosp, Clin & Translat Res Ctr, Biostat Unit, 35 Shinanomachi, Tokyo 1608582, Japan

[6] Hiroshima Univ, Dept Emergency & Crit Care Med, Minami Ku, Kasumi 1-2-3, Hiroshima 7348551, Japan

[7] Yokohama City Minato Red Cross Hosp, Dept Intens Care Med, 3-12-1,Shin Yamashita, Yokohama, Kanagawa 2318682, Japan

[8] Kurashiki Cent Hosp, Emergency & Crit Care Ctr, Dept Emergency Med, 1-1-1 Miwa, Kurashiki, Okayama 7108602, Japan

[9] Jikei Univ, Sch Med, Dept Anesthesiol, Intens Care Unit, 3-19-18,Nishishimbashi, Tokyo 1058471, Japan

[10] Toyonaka City Hosp, Dept Anesthesia, 1-14-4,Shibaraha Chou, Toyonaka, Osaka 5608565, Japan

[11] Sendai City Hosp, Div Intens Care, Emergency & Crit Care Dept, Taihaku Ku, 1-1-1,Asutonaga Chou, Sendai, Miyagi 9828502, Japan

[12] Kobe City Med Ctr, Gen Hosp, Dept Emergency Med, 2-2-1,Minatojima Minamimachi, Kobe, Hyogo 6500047, Japan

[13] Natl Hosp Org Kyoto Med Ctr, Dept Emergency & Crit Care Med, Fushimi Ku, 1-1 Mukaihata Cho, Kyoto, Kyoto 6120861, Japan

[14] Fukuoka City Hosp, Dept Emergency Med, Hakata ku, 1-13,Yoshizuka Honmachi, Fukuoka, Fukuoka 8120046, Japan

[15] Nippon Med Sch, Chiba Hokusoh Hosp, Shock & Trauma Ctr, Chiba 2701694, Japan

[16] Okayama Med Ctr, Dept Anesthesiol, Kita Ku, 1711-1,Taeki, Okayama, Okayama 7011192, Japan

[17] Tokyo Bay Urayasu Ichikawa Med Ctr, Dept Intens Care Med, 3-4-32,Toudaijima, Urayasu, Chiba 2790001, Japan

[18] Tohoku Med & Pharmaceut Univ Hosp, Div Infect Dis & Infect Control, Miyagino Ku, 1-12-1,Fukumuro, Sendai, Miyagi 9838512, Japan

[19] Saiseikai Kumamoto Hosp, Dept Acute Care & Gen Med, Minami Ku, 5-3-1,Chikami, Kumamoto, Kumamoto 8614193, Japan

[20] Takarazuka City Hosp, Dept Cent Lab & Infect Control, 4-5-1,Kohama, Takarazuka, Hyogo 6650827, Japan

[21] Jichi Med Univ, Dept Surg, 3311-1,Yakushiji, Simono, Tochigi 3290498, Japan

来源：

CRITICAL CARE | 2017年 / 21卷

关键词：

Chlorhexidine; Povidone-iodine; Catheter-related infections; Anti-infective agents; Local; Anti-bacterial agents; Catheters; 10-PERCENT POVIDONE-IODINE; BLOOD-STREAM INFECTIONS; CHLORHEXIDINE-GLUCONATE; ISOPROPYL-ALCOHOL; SITE CARE; TRIAL;

D O I：

10.1186/s13054-017-1890-z

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Background: To compare the efficacy of three antiseptic solutions [0.5%, and 1.0% alcohol/chlorhexidine gluconate (CHG), and 10% aqueous povidone-iodine (PVI)] for the prevention of intravascular catheter colonization, we conducted a randomized controlled trial in patients from 16 intensive care units in Japan. Methods: Adult patients undergoing central venous or arterial catheter insertions were randomized to have one of three antiseptic solutions applied during catheter insertion and dressing changes. The primary endpoint was the incidence of catheter colonization, and the secondary endpoint was the incidence of catheter-related bloodstream infections (CRBSI). Results: Of 1132 catheters randomized, 796 (70%) were included in the full analysis set. Catheter-tip colonization incidence was 3.7, 3.9, and 10.5 events per 1000 catheter-days in 0.5% CHG, 1% CHG, and PVI groups, respectively (p = 0.03). Pairwise comparisons of catheter colonization between groups showed a significantly higher catheter colonization risk in the PVI group (0.5% CHG vs. PVI: hazard ratio, HR 0.33 [95% confidence interval, CI 0.12-0.95], p = 0.04; 1.0% CHG vs. PVI: HR 0.35 [95% CI 0.13-0.93], p = 0.04). Sensitivity analyses including all patients by multiple imputations showed consistent quantitative conclusions (0.5% CHG vs. PVI: HR 0.34, p = 0.03; 1.0% CHG vs. PVI: HR 0.35, p = 0.04). No significant differences were observed in the incidence of CRBSI between groups. Conclusions: Both 0.5% and 1.0% alcohol CHG are superior to 10% aqueous PVI for the prevention of intravascular catheter colonization.

引用

页数：10

共 24 条

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