1615. The effectiveness of routine daily chlorhexidine (CHG) bathing in reducing Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae (KPC) skin burden among long-term acute care hospital (LTACH) patients
Session: Poster Abstract Session: Multidrug-Resistant Gram Negative Rods
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • idweek poster 2013_version0.5.pdf (122.6 kB)
  • Background: Whether daily CHG bathing reduces KPC skin colonization of LTACH patients is unclear. During a 4-LTACH control intervention that included daily CHG bathing by nursing staff, we assessed the effect on KPC skin burden.

    Methods: Randomly selected LTACH patients with KPC rectal colonization were assessed at 5 body sites (groin, back, antecubital, axilla, neck) immediately pre and post routine daily CHG baths (2% CHG cloths, Sage).  10x10 cm areas of skin were sampled using 2 dry flocked nylon swabs.  1 swab was cultured by a MacConkey agar-ertapenem disk method and the 2nd by a meropenem enrichment broth method.  Unique, screen-positive colonies were tested for blaKPC by PCR.  CHG  concentration at each site was measured using a 3rd swab and a semiquantitative colorimetric assay.  CHG MICs were determined by agar dilution.  Statistical testing was performed using Chi square, non-parametric tests, or Cochran-Mantel-Haenszel statistics.

    Results: We assessed 51 patients; the percent with at least 1 KPC positive skin site was higher among pre bath (61%) vs post bath patients (29%). Pre bath KPC colonization rates differed across skin sites (P<0.001) with 45% of axillary and 37% of groin sites KPC  positive (Table). Post bath KPC colonization rates were lower (9%) and did not differ by site (P=0.16).

    Median concentration of CHG on skin was higher among post vs pre bath patients (median, 312 vs 78 ug/mL, P<0.001) but differed across body sites (P<0.001); groin and axillary sites had highest median CHG values.

    The percent of skin sites with CHG concentrations above the KPC CHG MIC90 (128 ug/mL) was higher among post vs pre bath patients (75% vs 40%, P<0.001). For any skin site, a CHG concentration above the KPC MIC90 conferred a relative risk of 0.51 (95% CI, 0.34 to 0.77; P=0.002) for KPC skin colonization.

    CHGTable.gif

    Conclusion: CHG protected against KPC skin colonization, particularly if a skin concentration greater than the KPC CHG MIC90 was achieved. However, among LTACH patients rectally colonized with KPC and receiving routine daily CHG bathing, KPC skin colonization was still often detected, particularly at axillary and groin sites, and more often before the daily bath when skin CHG concentrations were lowest.  Whether KPC are resident colonizers of LTACH patients' skin warrants study.

    Michael Y. Lin, MD, MPH1, Donald Blom, RN, BA1, Rosie D. Lyles-Banks, MD, MHA2, Karen Lolans, BS3, Nicholas Moore, MS, MLS(ASCP)1, Shayna Weiner, MPH1, Caroline J. Thurlow, MD4, Monica K. Sikka, MD3, David W. Hines, MD5, Robert A Weinstein, MD, FIDSA1,2, Mary K Hayden, MD, FSHEA, FIDSA3 and for the CDC Prevention Epicenter Program, (1)Rush University Medical Center, Chicago, IL, (2)Cook County Health and Hospitals System, Chicago, IL, (3)Rush Univ. Med. Ctr., Chicago, IL, (4)Infectious Disease, Rush University Medical Center, Chicago, IL, (5)Metro Infectious Diseases Consultants, LLC, Burr Ridge, IL

    Disclosures:

    M. Y. Lin, None

    D. Blom, None

    R. D. Lyles-Banks, None

    K. Lolans, None

    N. Moore, None

    S. Weiner, None

    C. J. Thurlow, None

    M. K. Sikka, None

    D. W. Hines, None

    R. A. Weinstein, None

    M. K. Hayden, Sage Inc: ,

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