Chlorhexidine Gluconate (CHG) Susceptibility of Klebsiella pneumoniae Carbapenemase (KPC)-Producing K. pneumoniae Isolates From Skin Cultures of Patients in Long-Term Acute Care Hospitals (LTACHs)

Moore, Nicholas; Lolans, Karen; Fogg, Louis; Weiner, Shayna; Blom, Donald; Lyles, Rosie D.; Lin, Michael; Hines, David; Weinstein, Robert A.; Hayden, Mary K

doi:10.1093/ofid/ofv133.1341

Cited by 2 publications

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“…Microorganism in vitro CHG minimal inhibitory concentrations (MICs) vary, with gram-positive bacteria generally having lower MICs than gram-negative bacteria 15 (eg, the concentration of CHG required to inhibit 90% of methicillin-resistant Staphylococcus aureus strains is estimated at 4 μg/mL, 16 compared to 64 μg/mL for carbapenemresistant Klebsiella pneumoniae). 17 Whether a target level of CHG skin concentration is needed to reduce the bioburden of certain skin microorganisms is unclear. [18][19][20][21][22] A better understanding of the relationship between CHG skin concentrations, in vitro measurement of microbial susceptibility to CHG, and clinical outcomes is needed.…”

Section: Discussionmentioning

confidence: 99%

Impact of measurement and feedback on chlorhexidine gluconate bathing among intensive care unit patients: A multicenter study

Rhee,

Hayden,

Schoeny

et al. 2023

Infect. Control Hosp. Epidemiol.

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Objective:To assess whether measurement and feedback of chlorhexidine gluconate (CHG) skin concentrations can improve CHG bathing practice across multiple intensive care units (ICUs).Design:A before-and-after quality improvement study measuring patient CHG skin concentrations during 6 point-prevalence surveys (3 surveys each during baseline and intervention periods).Setting:The study was conducted across 7 geographically diverse ICUs with routine CHG bathing.Participants:Adult patients in the medical ICU.Methods:CHG skin concentrations were measured at the neck, axilla, and inguinal region using a semiquantitative colorimetric assay. Aggregate unit-level CHG skin concentration measurements from the baseline period and each intervention period survey were reported back to ICU leadership, which then used routine education and quality improvement activities to improve CHG bathing practice. We used multilevel linear models to assess the impact of intervention on CHG skin concentrations.Results:We enrolled 681 (93%) of 736 eligible patients; 92% received a CHG bath prior to survey. At baseline, CHG skin concentrations were lowest on the neck, compared to axillary or inguinal regions (P < .001). CHG was not detected on 33% of necks, 19% of axillae, and 18% of inguinal regions (P < .001 for differences in body sites). During the intervention period, ICUs that used CHG-impregnated cloths had a 3-fold increase in patient CHG skin concentrations as compared to baseline (P < .001).Conclusions:Routine CHG bathing performance in the ICU varied across multiple hospitals. Measurement and feedback of CHG skin concentrations can be an important tool to improve CHG bathing practice.

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Section: Discussionmentioning

confidence: 99%

Impact of measurement and feedback on chlorhexidine gluconate bathing among intensive care unit patients: A multicenter study

Rhee,

Hayden,

Schoeny

et al. 2023

Infect. Control Hosp. Epidemiol.

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“…There are few, if any, white blood cells and antibodies on the skin's surface to kill the bacteria, which could possibly reemerge when the antiseptic dissipates. Examples of using MIC testing to monitor for chlorhexidine-reduced susceptibility can be found in peer-reviewed studies by Popovich et al 29 and Climo et al 30 and also in presentation by Haffenreffer et al 31 and Moore et al 32 Testing for the qac -resistant genes, either alone or in combination with MIC or Minimum Bactericidal Concentration testing, may be a more valid technique to monitor for chlorhexidine-reduced susceptibility. The issue is not that a test has been shown to be invalid but that only validated tests should be used in research and to establish standards.…”

Section: Perspectivementioning

confidence: 99%

A Perspective on the Principles of Integrity in Infectious Disease Research

Kavanagh

Tower

Saman

2016

Journal of Patient Safety

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The medical literature is prone to overstating results, a condition not thoroughly recognized among policymakers. This article sets forth examples of potential problems with research integrity in the infectious disease literature. We describe articles that may be spun, categories lumped together in hopes of creating a significant effect (and sometimes an insignificant one), changes in metrics, and how trials may fail because of suboptimal interventions. When examined together, the examples show that the problems are widespread and illustrate the difficulty associated with interpreting medical research. The state of the current medical literature makes it of utmost importance that all sections of the manuscript are read, including associated letters to the editors and information on ClinicalTrials.gov before authors' recommendations are accepted.

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Chlorhexidine Gluconate (CHG) Susceptibility of Klebsiella pneumoniae Carbapenemase (KPC)-Producing K. pneumoniae Isolates From Skin Cultures of Patients in Long-Term Acute Care Hospitals (LTACHs)

Cited by 2 publications

References 0 publications

Impact of measurement and feedback on chlorhexidine gluconate bathing among intensive care unit patients: A multicenter study

Impact of measurement and feedback on chlorhexidine gluconate bathing among intensive care unit patients: A multicenter study

A Perspective on the Principles of Integrity in Infectious Disease Research

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