Efficacy of chlorhexidine patches on central line-associated bloodstream infections in children

Effectiveness of Chlorhexidine-Impregnated Central Venous Catheter Dressing for Preventing Catheter-Related Bloodstream Infections in Pediatric Patients: A Systematic Review and Meta-Analysis Study

Objective The study's objective was to use meta-analysis to assess the effectiveness of a dressing impregnated with chlorhexidine in preventing catheter-related bloodstream infections (CRBSIs) in pediatric patients.

Methods The study was conducted and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. A comprehensive search of 18 databases was conducted up to 5 March 2020 to identify related studies. Following the evaluation of the methodological quality, 8 studies, 1,584 catheters in 1,556 patients were added to the meta-analysis. The odds ratio and Hedge's G effect size value were employed to analyze the data. Either a fixed-effects model or a random-effects model was used to compute the effect size value with 95% confidence intervals (CIs). The heterogeneity of effect sizes was investigated using Cochrane Q statistics, I 2, and Tau2 tests. To test for publication bias, funnel plot, Orwin's safe n number, Begg and Mazumdar rank correlation, Egger test, and Duval and Tweedie's trim and fill procedures were all utilized.

Results The catheter colonization risk was lowered by 50.7% by the chlorhexidine-impregnated (C-I) dressing (odds ratio [OR] = 0.493 [%95 CI: 0.360–0.675]; p < 0.001). The use of C-I dressing was associated with a trend toward a decrease in CRBSIs, while this association was not statistically significant (OR = 0.858 [%95 CI: 0.567–1.300]; p = 0.471).

Conclusion The use of C-I dressing can effectively reduce the risk of catheter colonization, and it is also a helpful tactic in lowering CRBSIs in pediatric patients with central venous catheters, according to the findings of this meta-analysis.

Biofilm Formation on Central Venous Catheters: A Pilot Study

INTRODUCTION

Central line-associated bloodstream infection is a complication with serious consequences and biofilm development is thought to play a role. This study evaluated the impact of sterilization technique on central venous catheter (CVC) biofilm formation.

MATERIALS AND METHODS

This pilot study was conducted in the surgical intensive care unit of a tertiary care facility. All CVCs were inserted with chlorhexidine preparation (CHG). CHG-only CVCs were compared to the use of CHG with chlorhexidine gluconate-impregnated sponge (CHGIS). After removal, a punch biopsy of the CVC was taken at the noted skin level. Scanning electron microscopy identified the stage of biofilm. Confocal laser scanning microscopy with SYPRO stain confirmed the presence of glycocalyx and a volumetric analysis was completed.

RESULTS

Twenty four CVCs were collected. Indications for line placement were similar, with 42% placed for sepsis in the CHGIS group and 33% in the CHG group. There were no positive line cultures or bacteremia and 2/12 CHGIS patients had candidemia. CHGIS lines were in place for a mean of 91 h, compared to 60 h with CHG alone (P = 0.19). The interior of CVCs had lower stage biofilms than the exterior and lacked stage 4 biofilms. Stage 4 biofilms were present externally on 50% of CVCs (8/12 CHG and 4/12 CHGIS). Stage 3 biofilms were present on 7/12 CHG and 6/12 CHGIS interior samples. Volume analysis found an increase in biofilm and glycocalyx in CHGIS compared to CHG samples.

CONCLUSIONS

This study identified biofilms on both surfaces of CVCs. No significant difference in biofilm formation was found based on a sterilization technique.

Comparison of chlorhexidine impregnated dressing and standard dressing for the prevention of central-line associated blood stream infection and colonization in critically ill pediatric patients: A randomized controlled trial

BACKGROUND

The aim of this study was to compare chlorhexidine gluconate (CHG)-impregnated dressing and standard dressing with respect to the frequency of central-line-associated bloodstream infection (CLABSI), catheter-related bloodstream infection, primary bloodstream infection, and catheter colonization in critically ill pediatric patients with short-term central venous catheters.

METHODS

Children who were admitted to the pediatric intensive care unit of a tertiary institution between May 2018 and December 2019 and received placement of a short-term central venous catheter were included in this single-center randomized controlled trial. Patients were grouped according to the type of catheter fixation applied.

RESULTS

A total of 307 patients (151 CHG-impregnated dressing, 156 standard dressing), with 307 catheters (amounting to a collective total of 4,993 catheter days), were included in the study. The CHG-impregnated dressing did not significantly decrease the incidence of CLABSI (6.36 vs 7.59 per 1,000 catheter days; hazard ratio (HR): 0.93, P = 0.76), catheter related bloodstream infection (3.82 vs 4.18 per 1,000 catheter days; HR: 0.98; P = 0.98), and primary bloodstream infection (2.54 vs 3.42 catheter days; HR: 0.79; P = 0.67). The CHG-impregnated dressing significantly decreased the incidence of catheter colonization (3.82 vs 7.59 per 1,000 catheter days; HR: 0.40; P = 0.04). In both groups, the most frequent microorganisms isolated in CLABSI or catheter colonization were Gram-positive bacteria (the majority were coagulase-negative staphylococci).

CONCLUSIONS

The use of CHG-impregnated dressing does not decrease CLABSI incidence in critically ill pediatric patients but it significantly reduced catheter colonization. Coagulase-negative staphylococci were the most common microorganisms causing CLABSI or catheter colonization.