BOSTON — A 35% reduction in bacteremia was observed
in a cohort of critically ill children who received daily baths with
chlorhexidine gluconate, according to findings presented here at the IDSA 49th
Aaron Milstone, MD, assistant professor of
pediatrics and epidemiology at Johns Hopkins University and associate hospital
epidemiologist at Johns Hopkins Hospital, said daily bathing is not something
health care providers usually see as a means to prevent infections. “It is
usually done to soothe a child or remove dirt,” Milstone said.
The aim of the trial was to determine whether daily
bathing with 2% chlorhexidine gluconate impregnated cloths could reduce
bacteremia in children in a similar way that has been shown to reduce
bacteremia in adult ICU patients. “This practice is being used by some
ICUs already,” he said. “People are looking for new ways to tackle
bacteremia in hospitalized children. This is an easy-to-implement option that
can complement standard infection prevention strategies.”
On the patient level, a decrease of 35% in the incidence
of bacteremia was observed in the treatment cohort, as indicated by a per
protocol incidence rate ratio (IRR) of 0.65 (95% CI, 0.44-0.97). “A 35%
reduction is tremendous, and our findings were consistent across hospitals from
different geographic regions,” Milstone said.
A trend toward reduction in bacteremia incidence in ICUs
receiving treatment also was observed in the per protocol analysis (IRR=0.66;
95% CI, 0.43-1.01).
Intention to treat analysis results indicated a similar
trend, but one that was not statistically significant. At the patient level,
the IRR for bacteremia in the treatment group was 0.70 (95% CI, 0.43-1.13); at
the ICU level, the IRR was 0.69 (95% CI, 0.41-1.18).
Neither the patient-level nor the ICU-level results
indicated a statistically significant reduction in central line-associated
bloodstream infections (CLABSI) incidence in the per protocol or intention to
treat analyses. The patient-level per protocol analysis yielded an IRR of 0.72
(95% CI, 0.37-1.37), and the ICU-level per protocol analysis yielded an IRR of
0.72 (95% CI, 0.36-1.42). For the intention to treat analysis, the
patient-level IRR was 0.55 (95% CI, 0.25-1.17), and the ICU-level IRR was 0.55
(95% CI 0.25-1.21).
The proportion of gram-positive bacteremia incidence was
similar in the treatment and control groups (0.57 and 0.71, respectively;
The unmasked, controlled, cluster-randomized crossover
trial was conducted in 10 ICUs at five academic medical centers. Eligible
children were aged older than 2 months and were expected to stay in the ICU for
more than 2 days.
Incidence of bacteremia was the primary outcome.
Bacteremia was defined as any positive blood culture and included bacteremia
due to commensal organisms. Incidence of CLABSI was the main secondary outcome.
The researchers conducted planned efficacy (per
protocol) and effectiveness (intention to treat) analyses.
The final analysis included 4,961 patient visits, of
whom 2,422 were assigned to treatment and 2,525 were assigned to control.
There were 133 episodes of bacteremia reported.
Forty-two of those episodes were CLABSI.
Disclosure: Dr. Milstone reports being a grant
investigator for and receiving a research grant from Sage Products.
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