Chlorhexidine gluconate bathing reduces the incidence of bloodstream infections in adults undergoing inpatient hematopoietic cell transplantation Journal Article

   

Authors:	Giri, V. K.; Kegerreis, K. G.; Ren, Y.; Bohannon, L. M.; Lobaugh-Jin, E.; Messina, J. A.; Matthews, A.; Mowery, Y. M.; Sito, E.; Lassiter, M.; Saullo, J. L.; Jung, S. H.; Ma, L.; Greenberg, M.; Andermann, T. M.; van den Brink, M. R. M.; Peled, J. U.; Gomes, A. L. C.; Choi, T.; Gasparetto, C. J.; Horwitz, M. E.; Long, G. D.; Lopez, R. D.; Rizzieri, D. A.; Sarantopoulos, S.; Chao, N. J.; Allen, D. H.; Sung, A. D.
Article Title:	Chlorhexidine gluconate bathing reduces the incidence of bloodstream infections in adults undergoing inpatient hematopoietic cell transplantation
Abstract:	Bloodstream infections (BSIs) occur in 20% to 45% of inpatient autologous and allogeneic hematopoietic cell transplant (HCT) patients. Daily bathing with the antiseptic chlorhexidine gluconate (CHG) has been shown to reduce the incidence of BSIs in critically ill patients, although very few studies include HCT patients or have evaluated the impact of compliance on effectiveness. We conducted a prospective cohort study with historical controls to assess the impact of CHG bathing on the rate of BSIs and gut microbiota composition among adults undergoing inpatient HCT at the Duke University Medical Center. We present 1 year of data without CHG bathing (2016) and 2 years of data when CHG was used on the HCT unit (2017 and 2018). Because not all patients adhered to CHG, patients were grouped into four categories by rate of daily CHG usage: high (>75%), medium (50% to 75%), low (1% to 49%), and none (0%). Among 192 patients, univariate trend analysis demonstrated that increased CHG usage was associated with decreased incidence of clinically significant BSI, defined as any BSI requiring treatment by the medical team (high, 8% BSI; medium, 15.2%; low, 15.6%; no CHG, 30.3%; P =.003), laboratory-confirmed BSI (LCBI; P =.03), central line-associated BSI (P =.04), and mucosal barrier injury LCBI (MBI-LCBI; P =.002). Multivariate analysis confirmed a significant effect of CHG bathing on clinically significant BSI (P =.023) and MBI-LCBI (P =.007), without consistently impacting gut microbial diversity. Benefits of CHG bathing were most pronounced with >75% daily usage, and there were no adverse effects attributable to CHG. Adherence to daily CHG bathing significantly decreases the rate of bloodstream infection following HCT. © 2021 The American Society for Transplantation and Cellular Therapy
Keywords:	hematopoietic stem cell transplantation; bloodstream infection; chlorhexidine gluconate; microbiota; microbiome; blood and marrow transplantation; clabsi; mbi-lcbi
Journal Title:	Transplantation and Cellular Therapy
Volume:	27
Issue:	3
ISSN:	2666-6375
Publisher:	Elsevier Inc.
Date Published:	2021-03-01
Start Page:	262.e1
End Page:	262.e11
Language:	English
DOI:	10.1016/j.jtct.2021.01.004
PROVIDER:	scopus
PMCID:	PMC8010223
PUBMED:	33781532
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85101111818&doi=10.1016%2fj.jtct.2021.01.004&partnerID=40&md5=db83b03e53482bef4dfcb59eb1d236b4
Notes:	Article -- Export Date: 1 April 2021 -- Source: Scopus

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