Comparison of alcoholic chlorhexidine and povidone–iodine cutaneous antiseptics for the prevention of central venous catheter-related infection: a cohort and quasi-experimental multicenter study

Purpose Compare the effectiveness of different cutaneous antiseptics in reducing risk of catheter-related infection in intensive care unit (ICU) patients. Methods We compared the risk of central venous catheter-related infection according to four-step (scrub, rinse, dry, and disinfect) alcoholic 5 % povidone–iodine (PVI-a, n = 1521), one-step (disinfect) alcoholic 2 % chlorhexidine (2 % CHX-a, n = 1116), four-step alcoholic <1 % chlorhexidine (<1 % CHX-a, n = 357), and four-step aqueous 10 % povidone–iodine (PVI, n = 368) antiseptics used for cutaneous disinfection and catheter care during the 3SITES multicenter randomized controlled trial. Within this cohort, we performed a quasi-experimental study (i.e., before–after) involving the four ICUs which switched from PVI-a to 2 % CHX-a. We used propensity score matching (PSM, n = 776) and inverse probability weighting treatment (IPWT, n = 1592). The end point was the incidence of catheter-related infection (CRI) defined as catheter-related bloodstream infection (CRBSI) or a positive catheter tip culture plus clinical sepsis on catheter removal. Results In the cohort analysis and compared with PVI-a, the incidence of CRI was lower with 2 % CHX-a [adjusted hazard ratio (aHR), 0.51; 95 % confidence interval (CI) (0.28–0.96), p = 0.037] and similar with <1 % CHX-a [aHR, 0.73; (0.36–1.48), p = 0.37] and PVI [aHR, 1.50; 95 % CI (0.85–2.64), p = 0.16] after controlling for potential confounders. In the quasi-experimental study and compared with PVI-a, the incidence of catheter-related infection was again lower with 2 % CHX-a after PSM [HR, 0.35; 95 % CI (0.15, 0.84), p = 0.02] and in the IPWT analysis [HR, 0.31; 95 % CI (0.14, 0.70), p = 0.005]. The incidence of CRBSI or adverse event was not significantly different between antiseptics in all analyses. Conclusions In comparison with PVI-a, the use of 2 % CHX-a for cutaneous disinfection of the central venous catheter insertion site and maintenance catheter care was associated with a reduced risk of catheter infection, while the benefit of <1 % CHX-a was uncertain. Clinical trials identifier: NCT01479153..

Medienart:

E-Artikel

Erscheinungsjahr:

2016

Erschienen:

2016

Enthalten in:

Zur Gesamtaufnahme - volume:42

Enthalten in:

Intensive care medicine - 42(2016), 9 vom: 16. Juni, Seite 1418-1426

Sprache:

Englisch

Beteiligte Personen:

Pages, Justine [VerfasserIn]
Hazera, Pascal [VerfasserIn]
Mégarbane, Bruno [VerfasserIn]
du Cheyron, Damien [VerfasserIn]
Thuong, Marie [VerfasserIn]
Dutheil, Jean-Jacques [VerfasserIn]
Valette, Xavier [VerfasserIn]
Fournel, François [VerfasserIn]
Mermel, Leonard A. [VerfasserIn]
Mira, Jean-Paul [VerfasserIn]
Daubin, Cédric [VerfasserIn]
Parienti, Jean-Jacques [VerfasserIn]

Links:

Volltext [lizenzpflichtig]

BKL:

44.69$jIntensivmedizin

Themen:

Central venous catheter
Chlorhexidine
Cutaneous disinfection
Nosocomial infection
Povidone–iodine

RVK:

RVK Klassifikation

Anmerkungen:

© Springer-Verlag Berlin Heidelberg and ESICM 2016

doi:

10.1007/s00134-016-4406-4

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

OLC2096944600

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