Results of a systematic review and meta-analysis showed that daily chlorhexidine bathing is not associated with a lower risk for gram-negative infections.
Writing in Infection Control & Hospital Epidemiology, Aditi Patel, MD, internal medicine resident at Cleveland Clinic, and colleagues noted that previous research has shown that daily bathing with chlorhexidine gluconate (CHG) significantly reduces health care-associated infections (HAIs) caused by gram-positive bacteria, whereas its effect on gram-negative bacteria remains unclear.
For their study, Patel and colleagues searched online databases using the term “chlorhexidine bathing” to find published or unpublished individual or cluster randomized control trials and quasiexperimental studies that evaluated daily CHG bathing compared with soap and water in ICUs and non-ICUs. The searches were performed initially in November 2015 and again in July 2018.
The researchers calculated relative risk ratios for each study to determine the risk for developing a gram-negative HAI and evaluated the studies for publication bias. The meta-analysis included 12 studies involving 30,234 patients out of the 820 articles initially identified in the searches for the systematic review.
Patel and colleagues found that CHG bathing did not demonstrate a significant reduction of gram-negative infections when compared with control patients (RR = 0.89; 95% CI, 0.73-1.08). Secondary meta-analyses were performed on various studies to determine the impact CHG bathing had on infections caused by Acinetobacter (eight studies: RR = 0.67; 95% CI, 0.21-2.18), Klebsiella (six studies: RR = 0.57; 95% CI, 0.31-1.04), Enterobacter (five studies: RR = 0.75; 95% CI, 0.32-1.75) and Pseudomonas (seven studies: RR = 0.92; 95% CI, 0.61-1.4) and found that it did not significantly reduce infection from any of those pathogens.
A meta-analysis of six studies showed that CHG bathing significantly increased the risk for Escherichia coli infection (RR = 1.74; 95% CI, 1.03-2.92; P = .04).
“There is an urgent need for studies specifically designed to evaluate the impact of CHG bathing on the rates of gram-negative infections while also monitoring the rate of compliance with CHG bathing procedures and the skin levels of CHG after bathing,” the authors wrote. – by Erin Michael
Disclosures: Patel reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.