回复 1# icchina
感谢胡教授的信息传递。院感的理念观念传递了，影响力逐步扩大！
我记得在2009年，您来江苏宜兴，给我们授课，我坐第一排，近距离目睹风采。
您当时就说过，chlorhexidine是目前研究的热点和重点。希望我们有人能做这样的总结工作。
受您的指引和启示，我选择了洗必泰洗浴这个干预措施，运用META分析的研究手段，系统评价了他与CR-BSI，healthcare associated MDRO之间的关联。我发现，通过洗必泰洗浴可以显著降低ICU中获得性CR-BSI的发病率（包括CLABSI）（排版中，中国消毒学2011。6月左右）（TOPIC 1）。我还发现CHX可以显著降低MDRO的获得性定植（显著保护！！！），然而并没有降低healthcare associated MRSA or VRE菌血症的发病率。
TOPIC 2： 关于chlorhexidine bathing和MRSA，VRE之间的关联，我也整理成了英文。已投稿(under review)。由于英文杂志要求，所以我没有递交给SIFIC大会交流。
【现在黏贴摘要】Chlorhexidine is a common and safe antimicrobial agent and has been used widely in hand hygiene and skin disinfection; however, whether chlorhexidine bathing based decolonization (CHB-BD) among intensive care units (ICUs) patients results in the reduced acquisition of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) remains inconclusive. We did a meta-analysis searching PubMed and the Cochrane Central Register database for available studies conducted in ICU settings. Primary outcomes were the acquisition of MRSA, VRE and health care-associated bloodstream infection (HA-BSI) (including bacteremia). 11 articles reporting the outcome for more than 20,000 participants were available in this review. Overall we found that the application of CHB-BD would significantly reduce the acquired MRSA or VRE [relative risk (RR) = 0.56, 95% confidence interval (CI) = 0.42-0.76]. Subgroup analysis indicated that CHB-BD would significantly decrease acquired colonization of MRSA (RR = 0.52, 95% CI = 0.33-0.82) and VRE (RR = 0.47, 95% CI = 0.31-0.71). When stratifying incidence density of HA-BSIs for MRSA or VRE, no association was observed between lower incidence density of HA-BSIs and CHB-BD. CHB-BD among ICU patients would significantly decrease acquired colonization of MRSA and VRE, which may be an important complementary intervention to barrier precautions in the ICU settings. |
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发表于 2011-5-4 09:04
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