Chlorhexidine bathing for the prevention of colonization and infection with multidrug-resistant microorganisms in a hematopoietic stem cell transplantation unit over a 9-year period

Abstract

Health care associated infections (HAIs) are currently among the major challenges to the care of hematopoietic stem cell transplantation (HSCT) patients. The objective of the present study was to evaluate the impact of 2% chlorhexidine (CHG) bathing on the incidence of colonization and infection with vancomycin-resistant Enterococcus (VRE), multidrug-resistant (MDR) gram-negative pathogens, and to evaluate their CHG minimum inhibitory concentration (MIC) after the intervention.A quasi-experimental study with duration of 9 years was conducted. VRE colonization and infection, HAI rates, and MDR gram-negative infection were evaluated by interrupted time series analysis. The antibacterial susceptibility profile and mechanism of resistance to CHG were analyzed in both periods by the agar dilution method in the presence or absence of the efflux pump inhibitor carbonyl cyanide-m-chlorophenyl hydrazone (CCCP) and presence of efflux pumps (qacA/E, qacA, qacE, cepA, AdeA, AdeB, and AdeC) by polymerase chain reaction (PCR).The VRE colonization and infection rates were significantly reduced in the postintervention period (P = 0.001). However, gram-negative MDR rates in the unit increased in the last years of the study. The CHG MICs for VRE increased during the period of exposure to the antiseptic. A higher MIC at baseline period was observed in MDR gram-negative strains. The emergence of a monoclonal Pseudomonas aeruginosa clone was observed in the second period.Concluding, CHG bathing was efficient regarding VRE colonization and infection, whereas no similar results were found with MDR gram-negative bacteria.

Use of a chlorhexidine-impregnated dressing reduced catheter-related bloodstream infections caused by Gram-positive microorganisms

“… 14 Mendes et al also found that Vancomycin Resistant Enterococcus (VRE) colonization and infection rates fell when CH soaps were used for bathing, but the Gram-negative infection rate was not affected. 15 Moreover, Petlin et al found that the rate of infection with methicillin-resistant Staphylococcus aureus fell upon bathing with CH soap. 16 We found that the CHG dressing prevented Gram-positive CRBSIs.…”

Update on infection control practices in cancer hospitals

“…However, this impact has not been reproduced in other studies . Interestingly, in a recent report, the use of a chlorhexidine wash was associated with an increased risk of infections caused by MDR‐GNB, including carbapenem‐resistant Enterobacteriaceae, as well as the development of reduced susceptibility to chlorhexidine and the presence of efflux‐mediated resistance genes in staphylococci …”

“…Some practices, such as antiseptic whole‐body washing or bathing of patients, have been shown by some researchers to reduce VRE and MRSA colonization and infections in hematologic units and have been proposed by some for selected patients with recurrent MRSA soft tissue infections . However, this impact has not been reproduced in other studies .…”

Infektionsprävention und VRE: eine unendliche Geschichte

“…[32]. Eine signifikante Reduktion von VRE-Kolonisationen und -Infektionen durch Chlorhexidin-Waschungen konnte auch bei einer 9 Jahre dauernden Studie auf einer Stammzelltransplantationseinheit in Brasilien gezeigt werden [33]. Allerdings ergaben sich auch deutlich negative Nebeneffekte in Form von erhöhter MHK (minimale Hemmkonzentration) gegenüber Chlorhexidin, einer Häufung gramnegativer Infektionen sowie eines Ausbruchs mit multiresistentem P. aeruginosa.…”