LB-36. Daily Chlorhexidine Gluconate (CHG) Bathing Reduces Bacteremia in Critically Ill Children: Result from a Multicenter, Cluster Randomized, Controlled, Crossover Trial
Session: Oral Abstract Session: Late Breaker Oral Abstracts
Saturday, October 22, 2011: 6:45 PM
Room: 156ABC
Background: Recent studies suggest that daily CHG baths may reduce the incidence of bacteremia in adult intensive care units (ICU). Our objective was to determine if daily bathing with 2% CHG impregnated cloths compared with standard bathing practices would reduce bacteremia in critically ill children. 

Method: We performed an unmasked, controlled, cluster-randomized crossover trial in 10 ICUs at 5 academic medical centers. Patients more than 2 months of age with an expected duration of stay of more than two days were eligible. The primary outcome was bacteremia defined as any positive blood culture and included those due to commensal organisms. The main secondary outcome was central line-associated bloodstream infections (CLABSI). Planned efficacy (per protocol [PP]) and effectiveness (intent to treat [ITT]) analyses were performed. The treatment effect was estimated by adjusted incidence rate ratios (IRR) at the patient-level (patient IRR) and the ICU-level (ICU IRR).

Result: 4,961 patient visits were randomized: 2422 to treatment and 2525 to control. There were 133 episodes of bacteremia of which 42 were CLABSI. There was a 35% decrease in the incidence of bacteremia in patients receiving treatment (PP; IRR 0.65, 95%CI 0.44-0.97) and a trend toward a reduction in incidence of bacteremia in ICUs receiving treatment (PP; IRR 0.66, 95%CI 0.43-1.01). A similar, but not statistically significant, treatment effect was seen in the ITT analysis (patient IRR 0.70, 95%CI 0.43-1.13; ICU IRR 0.69, 95%CI 0.41-1.18). There was not a statistically significant decrease in the incidence of CLABSI in patients or ICUs receiving treatment in the PP or ITT analyses ([PP; patient IRR 0.72, 95%CI 0.37-1.37, ICU IRR 0.72, 95%CI 0.36-1.42]; [ITT, patient IRR 0.55, 95%CI 0.25-1.17, ICU IRR 0.55, 95%CI 0.25-1.21]). There was no difference in the proportion of bacteremias due to Gram positive organisms in the treatment and control groups (0.57 and 0.71, p=.14).

Conclusion: Daily CHG bathing reduces bacteremia in critically ill children. As CLABSIs become less frequent, larger studies may be needed to confirm our observed but not statistically significant reduction in CLABSI. 


Subject Category: P. Pediatric and perinatal infections

Aaron Milstone, MD, MHS1, Alexis Elward, MD, MPH2, Xiaoyan Song, PhD, MBBS3, Danielle Zerr, MD, MPH4, Rachel Orscheln, MD5, Kathleen Speck, MPH6, Daniel Obeng, MB MSc7, Nick Reich, PhD7, Susan Coffin, MD, MPH8 and Trish Perl, MD, MSc, FIDSA9, (1)The Johns Hopkins Medical Institution, Baltimore, MD, (2)Washington University School of Medicine, St Louis, MO, (3)Children's National Medical Center, Washington, DC, (4)Department of Pediatrics, University of Washington, Seattle, WA, (5)Pediatrics, Washington University in St. Louis, St. Louis, MO, (6)Johns Hopkins University, Baltimore, MD, (7)Biostatistics, Johns Hopkins University, Baltimore, MD, (8)University of Pennsylvania, Philadelphia, PA, (9)Johns Hopkins Medical Institutions, Baltimore, MD

Disclosures:

A. Milstone, Sage Products, Inc: Grant Investigator, Research grant

A. Elward, Sage Products, Ltd: Grant Investigator, Grant recipient

X. Song, Sage Products, Inc.: Grant Investigator, Research grant

D. Zerr, Sage products, Inc.: Grant Investigator, Research grant
Vioguard, Ltd.: Grant Investigator, Research grant
NIH/NIAID: Grant Investigator, Research grant

R. Orscheln, Sage Products, Inc.: Grant Investigator, Research grant

K. Speck, Sage Products, Inc: Grant Investigator, Research support

D. Obeng, Sage Products, Inc.: Grant Investigator, Research support

N. Reich, None

S. Coffin, Sage Products: Grant Investigator, Research grant and Research support

T. Perl, Sage: Grant Investigator, Research grant

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.