氯己定擦浴预防ICU患者院内感染的Meta分析

Effect of chlorhexidine bathing on preventing health care-associated infections in ICU patients: A meta-analysis

  • 摘要: 目的 探讨每日氯己定擦浴预防ICU患者院内感染的效果。 方法 通过检索Pubmed、EMBASE、Cochrane Library、Web of Science database、中国知网、万方数据库获得相关文献,由两名研究者独立提取数据,并根据Cochrane风险评估工具进行质量评价,运用Review Manager5.3软件进行相关数据分析。 结果 最终纳入13个研究,包括12篇英文和1篇中文,5个为随机对照试验,8个为类实验研究。与对照组相比,氯己定擦浴组中心静脉导管相关性血流感染率降低37%(RR=0.64,95% CI:0.55 ~ 0.74,P< 0.001),皮肤表面耐甲氧西林金黄色葡萄球菌感染率下降 45%(RR=0.51,95% CI:0.40 ~ 0.64,P< 0.001),导管相关性尿路感染率氯己定擦浴组(每千导管日2.41例感染)低于对照组(每千导管日2.43例感染),呼吸机相关性肺炎感染率氯己定擦浴组(每千导管日2.03例感染)低于对照组(每千导管日2.35例感染),但差异均无统计学意义。 结论 每日氯己定擦浴对ICU患者院内感染有一定程度的预防作用,可能与皮肤表面革兰阳性菌的减少有关。

     

    Abstract: Objective To assess the effects of chlorhexidine gluconate (CHG) bathing on health care–associated infections in ICU patients. Methods This meta-analysis evaluated studies from the PubMed, EMBASE, Cochrane Library, Web of Science database CNKI, WANFANG DATA and VIP. Two reviewers independently extracted data from included studies. The Cochrane Collaboration tool was used to evaluate all publications. Data were analyzed by Revman 5.3. Results Totally 13 trials were included, with 5 RCTs and 8 quasi-experimental studies. Compared with the control group, the intervention of CHG reduced the risk of central line-associated blood stream infection (CLABSI) by 37% (RR=0.64, 95% CI: 0.55-0.74, P< 0.001), skin infection by methicillinresistant staphylococcus aureus (MRSA) decreased by 45% (RR=0.51, 95% CI: 0.40-0.64, P< 0.001). There was no significant difference in incidence of catheter-associated urinary tract infection (CAUTI) between daily CHG bathing group (2.41 per 1 000 catheter-days) and standard bathing group (2.43 per 1 000 catheter-days), and incidence of ventilator-associated pneumonia (VAP) in daily CHG bathing group (2.03 per 1 000 ventilator-days) was not significantly different with that of standard bathing group (2.35 per 1 000 ventilator-days). Conclusion This meta-analysis reveals evidence for the benefit of daily bathing with CHG in reducing health care-associated infections, which may be associated with the decreasing of gram-positive bacteria on the skin.

     

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