1135. Assessment of chlorhexidine gluconate (CHG) resistance in the setting of suboptimal compliance of CHG use on medical inpatient units
Session: Poster Abstract Session: MRSA/VRE Epidemiology
Friday, October 9, 2015
Room: Poster Hall
Posters
  • CHG resistance poster IDweek_v1.pdf (439.4 kB)
  • Background: Patient bathing with chlorhexidine gluconate (CHG) is being increasingly used as a horizontal approach to prevent nosocomial infections. Bathing compliance is critical to ensure the effectiveness of this approach, and poor compliance may result in the development of CHG resistance. After trialing CHG cloths on medical inpatients in an urban, academic hospital, compliance was estimated at 62%. This study sought to determine if resistance was induced in the context of suboptimal compliance.

    Methods: A 6-month prospective study of CHG on 4 medical wards was conducted from June 2 – December 2, 2014, with 2 wards serving as controls, at an urban, academic hospital in Vancouver, Canada. All nosocomial isolates of methicillin-resistant Staphylococcus aureus (MRSA) from any clinical site [>3 days after admission or ≤3 days with a previous admission in the past 4 weeks], as well as all blood cultures positive for methicillin-susceptible Staphylococcus aureus (MSSA) identified >3 days after admission were included. For patients with multiple isolates, only the first isolate was tested. An in-house developed real-time PCR for the qacA/B and smr genes was utilized. Statistical analysis was based on Fisher’s exact test.

    Results: 21 S. aureus isolates were identified during the study period, including 19 MRSA and 2 MSSA.  Of the 21 isolates, 6 were recovered from the intervention wards and 15 from the control wards. One MRSA isolate (sputum) was positive for qacA/B and 1 MSSA isolate (blood) was positive for smr on the CHG intervention wards. For patients on the intervention unit, median time to identification of a nosocomial MRSA was 7 days (estimated time of potential exposure to CHG use on the unit).  No qacA/B or smr positive isolates were identified on the control wards (2/6 vs 0/15, p=0.07).

    Conclusion: No significant difference in the detection of qacA/B and smr genes were identified in S. aureus recovered from the intervention wards utilizing CHG, despite a compliance of 62% over a 6-month period. However, continued monitoring for resistance is required, particularly for non-ICU settings in which selection of resistant strains may theoretically occur due to the likelihood of suboptimal compliance.

    Christopher F. Lowe, MD, FRCPC1,2,3, Gordon Ritchie, PhD, FACB2,3, Baljinder Sidhu, RN, CIC1, Azra Sharma, MLT, MSc1, Willson Jang, BSc, MLT2, Anna Wong, BSc, MLT2, Victor Leung, MD, FRCPC4, Sylvie Champagne, MD, FRCPC2,3, Elisa Lloyd-Smith, PhD1 and Marc G. Romney, MD, FRCPC, DTM&H2, (1)Infection Prevention and Control, Providence Health Care, Vancouver, BC, Canada, (2)Pathology and Laboratory Medicine, Providence Health Care, Vancouver, BC, Canada, (3)Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada, (4)Pathology and Laboratory Medicine, Infectious Diseases, Providence Health Care, Vancouver, BC, Canada

    Disclosures:

    C. F. Lowe, Sage Products: Grant Investigator , Research grant

    G. Ritchie, Sage Products: Investigator , Research grant

    B. Sidhu, None

    A. Sharma, None

    W. Jang, None

    A. Wong, None

    V. Leung, None

    S. Champagne, None

    E. Lloyd-Smith, Sage Products: Investigator , Research grant

    M. G. Romney, Sage Products: Investigator , Research grant

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.