Results of a real-world study found that daily bathing with 2% chlorhexidine gluconate (CHG) may effectively decrease the risk for vancomycin-resistant enterococci (VRE) transmission among patients in an intensive care unit (ICU) with increased VRE endemicity. These findings were published Antimicrobial Resistance and Infection Control.
Investigators conducted a prospective, interrupted time-series (ITS) analysis with a 6-month CHG bathing intervention among adult patients admitted to an ICU for more than72 hours. The study comprised a pre-intervention period from September 2016 to February 2017, and an intervention period from July 2017 to December 2017. Patients included in the pre-intervention period underwent standard soap and water bathing twice weekly and those included in the intervention period underwent daily bathing with 2% CHG.
The investigators compared the acquisition and incidence of VRE, methicillin-resistant Staphylococcus aureus (MRSA), and carbapenem-resistant Acinetobacter baumannii (CRAB) between the pre-intervention and intervention periods. The primary outcome was change in the rate of rectal VRE acquisition, and the secondary outcome was the incidence of VRE, MRSA, or CRAB.
Among a total of 501 patients included in the study, 259 were enrolled in the pre-intervention period and 242 were enrolled in the intervention period. Of patients included in the study, the median age was approximately 73 years, and the majority of patients were men. The overall rate of adherence to CHG bathing was 72.5%, with nonadherence most often reported in patients who were critically ill.
The investigators noted that the rate of rectal VRE acquisition decreased significantly between the pre-intervention (20.17 per 1000 patient-days) and intervention (9.35 per 1000 patient-days) periods (P <.001). Results of the ITS analysis showed that the risk for VRE acquisition decreased by 58% among patients who underwent daily bathing with 2% CHG (95% CI, 7.1-82.1; P =.038). No significant effects were observed in regard to the incidence of VRE, MRSA, or CRAB on analysis of clinical cultures obtained from patients included in both the pre-intervention and intervention periods.
This study was limited by its quasi-experimental design and single-center setting, the lack of randomization or a control arm, and that the pre-intervention and intervention periods did not cover the same months and seasons. In addition, the investigators did not analyze multi-drug resistant organisms for CHG resistance.
According to the investigators, “CHG bathing, as a universal decolonization strategy, might be an adjunctive control measure to [decrease] cross-transmission of VRE until more effective measures become available.”
Suh JW, Kim NH, Lee MJ, et al. Real-world experience of how chlorhexidine bathing affects the acquisition and incidence of vancomycin-resistant enterococci (VRE) in a medical intensive care unit with VRE endemicity: a prospective interrupted time-series study. Antimicrob Resist Infect Control. Published online November 10, 2021. doi:10.1186/s13756-021-01030-6