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.

中文翻译：

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每日辛烯定消毒浴对 ICU 获得性菌血症和 ICU 获得性多重耐药微生物的影响：一项多中心、整群随机、双盲、安慰剂对照、交叉研究

 目的

消毒沐浴已引起人们的关注，以减少医院获得性感染。先前的研究表明，在重症监护病房 （ICU） 等高风险环境中使用洗必泰进行消毒沐浴的疗效。在这项研究中，我们旨在评估辛烯定作为潜在替代品的有效性，因为它在欧洲已经流行和广泛使用。

 方法

在一项使用辛烯定浸渍和安慰剂毛巾的多中心、整群随机、双盲、安慰剂对照、交叉研究中，我们比较了 ICU 获得性原发性菌血症和 ICU 获得性多重耐药微生物 （MDROs） 的发生率。在德国 23 家医院的 44 个 ICU 中，我们将各个 ICU 与两个 12 个月时间段内的 ICU 进行了比较。所有数据均通过医院信息系统以数字方式获得，作为个体病房移动数据和微生物学测试结果;两个端点都是通过算法派生的。

 结果

分析了 93,438 名患者的 104,039 例 ICU 发作和 712,784 次微生物学检测结果，从而检测到 1508 例 ICU 获得性原发性菌血症和 1871 例 ICU 获得性 MDRO。用辛烯定浸渍的毛巾洗澡可预防 ICU 获得性原发性菌血症;在所有参与的 ICU 中，风险降低 17% （调整后的风险比 （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%）。然而，对ICU获得性MDROs没有观察到干预效果（校正HR 0.98， 95% CI [0.83;1.15]）。ICU 内干预对 MDRO 获得的影响存在很大异质性。

 结论

辛烯定消毒沐浴可能有效预防 ICU 获得性原发性菌血症，特别是由于革兰氏阳性菌和常见的皮肤共生菌血症。