التفاصيل البيبلوغرافية
| العنوان: |
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. |
| المؤلفون: |
Cheyron, Damien, Parienti, Jean-Jacques, Pages, Justine1, Dutheil, Jean-Jacques1, Fournel, François1, Hazera, Pascal2, Mégarbane, Bruno3, Thuong, Marie4, Valette, Xavier5, Daubin, Cédric5, Mermel, Leonard6, Mira, Jean-Paul7, Mégarbane, Bruno8 (AUTHOR), du Cheyron, Damien9,10 (AUTHOR), Fournel, François11 (AUTHOR), Mermel, Leonard A12 (AUTHOR), Daubin, Cédric9 (AUTHOR), 3SITES Study Group (CORPORATE AUTHOR) |
| المصدر: |
Intensive Care Medicine. Sep2016, Vol. 42 Issue 9, p1418-1426. 9p. |
| مصطلحات موضوعية: |
*CENTRAL venous catheters, *NOSOCOMIAL infections, *CUTANEOUS therapeutics, *CHLORHEXIDINE, *POVIDONE-iodine, *THERAPEUTICS, *BACTERICIDES, *COMPARATIVE studies, *DRUG administration, *LONGITUDINAL method, *RESEARCH methodology, *MEDICAL cooperation, *RESEARCH, *STATISTICAL sampling, *TRANSDERMAL medication, *EVALUATION research, *RANDOMIZED controlled trials, *RELATIVE medical risk, *DISEASE incidence, *CATHETER-related infections, *INFECTION prevention |
| مستخلص: |
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. [ABSTRACT FROM AUTHOR] |
| قاعدة البيانات: |
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