Impact of 4% chlorhexidine whole-body washing on multidrug-resistant Acinetobacter baumannii skin colonisation among patients in a medical intensive care unit
ABSTRACT The prevalence of skin colonisation with Acinetobacter baumannii (ACBA) on admission to the medical intensive care unit (MICU) was studied in an institution endemic for ACBA bloodstream infections (BSIs). The impact of 4% chlorhexidine gluconate (4% CG) whole-body washing on the patients' ACBA skin colonisation was also determined. A prospective cohort trial in a MICU during March 2002 to December 2003 was performed, with a comparison between the prevalence and incidence of ACBA-BSIs obtained after intervention and retrospectively. During the intervention period, ACBA skin-screening swabs were taken from all patients on admission and periodically until discharge. Patients underwent whole-body disinfection with 4% CG immediately after obtaining the initial cultures. Disinfection was carried out on a daily basis until discharge, regardless of colonisation status. Of the 320 patients at ward admission, 55 (17%) yielded ACBA. The prevalence of ACBA colonisation among the remaining MICU patients was 5.5% at 24h and 1% at 48h following the disinfection regimen (P=0.002, OR: 2.4). Following a second screen, 80% of colonised patients were decolonised. Prevalence of ACBA-BSIs decreased from 4.6 to 0.6 per 100 patients (P < or = 0.001; OR: 7.6) and incidence decreased from 7.8 to 1.25 (85% reduction). We conclude that daily whole-body disinfection with 4% CG significantly reduced ACBA skin colonisation. This regimen may be considered in addition to well-known infection control measures, particularly in institutions with endemic rates of multidrug-resistant ACBA-BSIs.
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- "Total body washing and bathing with 4% chlorhexidine gluconate has been shown to be effective in reducing skin colonisation with multidrug-resistant micro-organisms, such as vancomycinresistant enterococci and carbapenem-resistant Acinetobacter spp.   . Skin washing with octenidine hydrochloride and 2- phenoxyethanol also appears to be effective in similar situations . "
ABSTRACT: After a single patient was transferred to Leipzig University Hospital from a hospital in Rhodes, Greece, the hospital experienced the largest outbreak due to a KPC-2-producing Klebsiella pneumoniae (KPC-2-KP) strain thus far observed in Germany. Ninety patients hospitalised between July 2010 and October 2012 were affected. In an attempt to eliminate KPC-2-KP from their digestive tracts, 14 consecutive patients (16%) were treated with a short course (7 days) of selective digestive decontamination (SDD), employing colistin (1 million units q.i.d.) and gentamicin (80mg q.i.d.) as oral solutions, and applying colistin/gentamicin gel (0.5g) to the oral cavity. In a retrospective analysis, these 14 SDD patients were compared with the remaining 76 patients harbouring KPC-2-KP. KPC-2-KP carrier status was followed in all 14 SDD patients by submitting stool samples to KPC-specific PCR. The mean follow-up period was 48 days (range 12-103 days). Successful elimination of KPC-2-KP was defined as a minimum of three consecutive negative PCR test results separated by ≥48h each. Decolonisation of KPC-2-KP was achieved in 6/14 patients (43%) after a mean of 21 days (range 12-40 days), but was also observed in 23/76 (30%) of the non-SDD controls (P=0.102). SDD treatment resulted in the development of secondary resistance to colistin (19% increase in resistance rate) and gentamicin (45% increase) in post-treatment isolates. In the control group, no secondary resistance occurred. We conclude that the SDD protocol applied in this study was not sufficiently effective for decolonisation and was associated with resistance development.International journal of antimicrobial agents 09/2013; 42(6). DOI:10.1016/j.ijantimicag.2013.08.008 · 4.26 Impact Factor
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ABSTRACT: Over the last several years, an increasing number of hospitals have implemented a “search and destroy” strategy for methicillin-resistant Staphylococcus aureus (MRSA) based on the successful use of this approach in The Netherlands. However, the effectiveness of this strategy for reducing high endemic rates of MRSA remains unclear, the cost is high, and there are significant unintended consequences. Alternative methods to control MRSA should be attempted, and a successful approach targeted to reduce infections from all pathogens is outlined and recommended.Clinical Microbiology Newsletter 08/2008; 30(16):121-124. DOI:10.1016/j.clinmicnews.2008.07.004
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ABSTRACT: The development of antimicrobial resistant pathogens in surgical patients is a significant problem, and infections caused by these organisms are associated with increased morbidity and mortality. Programs to prevent the spread of resistant organisms emphasize standard infection control practices and appropriate antibiotic prescribing practices. Antibiotic restriction and selective reporting of bacterial susceptibilities have had limited success in decreasing development of resistance, and are difficult to maintain effectively in the absence of widespread clinician acceptance. Potentially more promising are integrated decision support tools, which can support optimal antibiotic selection while preserving the sense of clinician autonomy. The use of antibiotic cycling programs for critically ill patients may be another approach to preserving the efficacy of the currently antimicrobial against the continued pressure of increasing bacterial resistance.Surgical Clinics of North America 05/2009; 89(2):501-19, x. DOI:10.1016/j.suc.2008.09.011 · 1.93 Impact Factor