用辛烯胺每天消毒洗澡对重症监护室获得性菌血症和重症监护室获得性多重耐药菌的影响：一项多中心、分组随机、双盲、安慰剂对照、交叉研究

IF 27.1 1区医学 Q1 CRITICAL CARE MEDICINE

Intensive Care Medicine Pub Date : 2024-10-17 DOI:10.1007/s00134-024-07667-2

Tiffany Schaumburg, Norbert Köhler, Yasmine Breitenstein, Susanne Kolbe-Busch, Dirk Hasenclever, Iris F. Chaberny

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引用次数: 0

摘要

目的为减少医院感染，消毒沐浴备受关注。以往的研究表明，在重症监护室（ICU）等高风险环境中使用洗必泰进行消毒沐浴效果显著。我们在一项多中心、群组随机、双盲、安慰剂对照、交叉研究中，使用辛替尼定浸渍过的毛巾和安慰剂毛巾，比较了 ICU 获得性原发性菌血症和 ICU 获得性多重耐药菌 (MDRO) 的发病率。在全德国 23 家医院的 44 个重症监护室中，我们对各个重症监护室在两个 12 个月期间的情况进行了比较。所有数据都是通过医院信息系统以数字形式获得的，包括个人病房移动数据和微生物检测结果；两个终点都是通过算法得出的。结果分析了来自 93438 名患者的 14039 个 ICU 病例和 712784 个微生物检测结果，从而发现了 1508 例 ICU 获得性原发性菌血症和 1871 例 ICU 获得性 MDRO。用浸过辛烯胺的浴巾洗澡可预防 ICU 获得性原发性菌血症；所有参与研究的 ICU 的风险均降低了 17%（调整后危险比 (HR) 0.83，95% 置信区间 (CI) [0.75; 0.92]，p = 0.0003）。这种减少主要影响凝固酶阴性葡萄球菌（53%）和肠球菌（17%）。但是，对 ICU 获得性 MDROs 没有干预效果（调整 HR 0.98，95% CI [0.83; 1.15]）。结论使用辛烯胺进行消毒沐浴可有效预防ICU获得性原发性菌血症，尤其是革兰氏阳性菌和常见皮肤共生菌引起的菌血症。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

EFFECT of daily antiseptic bathing with octenidine on ICU-acquired bacteremia and ICU-acquired multidrug-resistant organisms: a multicenter, cluster-randomized, double-blind, placebo-controlled, cross-over study

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Purpose

Antiseptic bathing has garnered attention in an effort to reduce hospital-acquired infections. Previous studies have shown the efficacy of antiseptic bathing in high-risk environments, such as intensive care units (ICUs), using chlorhexidine. In this study we aimed to evaluate the effectiveness of octenidine as a potential alternative due to its established popularity and widespread use in Europe.

Methods

We compared the rates of ICU-acquired primary bacteremia and ICU-acquired multidrug-resistant organisms (MDROs) in a multicenter, cluster-randomized, double-blind, placebo-controlled, cross-over study using octenidine-impregnated and placebo washcloths. On 44 ICUs in 23 hospitals throughout Germany, we compared individual ICUs with themselves over two 12-month time periods. All data were obtained digitally via hospital information systems as individual ward-movement data and microbiological test results; both endpoints were algorithmically derived.

Results

104,039 ICU episodes from 93,438 patients with 712,784 microbiological test results were analyzed, thereby detecting 1508 cases of ICU-acquired primary bacteremia and 1871 cases of ICU-acquired MDRO. Bathing with octenidine-impregnated washcloths prevented ICU-acquired primary bacteremia; a risk reduction of 17% was seen homogeneously across all participating ICUs (adjusted hazard ratio (HR) 0.83, 95% confidence interval (CI) [0.75; 0.92], p = 0.0003). This reduction affected predominantly coagulase-negative staphylococci (53%) and enterococci (17%). However, no intervention effect was seen for ICU-acquired MDROs (adjusted HR 0.98, 95% CI [0.83; 1.15]). Heterogeneity among intra-ICU intervention effects on MDRO acquisition was substantial.

Conclusions

Antiseptic bathing with octenidine may be effective in preventing ICU-acquired primary bacteremia, particularly due to Gram-positive bacteria and common skin commensals.

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来源期刊

Intensive Care Medicine 医学-危重病医学

CiteScore

51.50

自引率

2.80%

发文量

326

审稿时长

1 months

期刊介绍： Intensive Care Medicine is the premier publication platform fostering the communication and exchange of cutting-edge research and ideas within the field of intensive care medicine on a comprehensive scale. Catering to professionals involved in intensive medical care, including intensivists, medical specialists, nurses, and other healthcare professionals, ICM stands as the official journal of The European Society of Intensive Care Medicine. ICM is dedicated to advancing the understanding and practice of intensive care medicine among professionals in Europe and beyond. The journal provides a robust platform for disseminating current research findings and innovative ideas in intensive care medicine. Content published in Intensive Care Medicine encompasses a wide range, including review articles, original research papers, letters, reviews, debates, and more.