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Crit Care. 2017 Dec 21;21(1):320. doi: 10.1186/s13054-017-1890-z.

Comparison of the efficacy of three topical antiseptic solutions for the prevention of catheter colonization: a multicenter randomized controlled study.

Author information

1
Intensive Care Unit, Department of Emergency and Critical Care Medicine, Japanese Red Cross Musashino Hospital, 1-26-1, Kyounanchou, Musashino-shi, Tokyo, 180-8610, Japan.
2
Department of Intensive Care Unit, Kameda General Hospital, 929 Higashi-cho, Kamogawa City, Chiba Prefecture, 296-8602, Japan.
3
Department of Preventive Medicine and Public Health, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
4
Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847, Amanuma-cho, Omiya-ku, Saitama-shi, Saitama, 330-8503, Japan. msanui@mac.com.
5
Biostatistics Unit at Clinical and Translational Research Center, Keio University Hospital, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
6
Department of Emergency and Critical Care Medicine, Hiroshima University, Kasumi 1-2-3 Minami-ku, Hiroshima, 734-8551, Japan.
7
Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847, Amanuma-cho, Omiya-ku, Saitama-shi, Saitama, 330-8503, Japan.
8
Department of Intensive Care Medicine, Yokohama City Minato Red Cross Hospital, 3-12-1, Shin-yamashita, Naka-ku, Yokohama-Shi, Kanagawa, 231-8682, Japan.
9
Department of Emergency Medicine, Emergency and Critical Care Center, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan.
10
Intensive Care Unit, Department of Anesthesiology, Jikei University School of Medicine, 3-19-18, Nishishimbashi, Minato-ku, Tokyo, 105-8471, Japan.
11
Department of Anesthesia, Toyonaka Municipal Hospital, 1-14-4, Shibaraha-chou, Toyonaka-shi, Osaka, 560-8565, Japan.
12
Emergency and Critical Care Department, Division of Intensive Care, Sendai City Hospital, 1-1-1, Asutonaga-chou, Taihaku-ku, Sendai-shi, Miyagi, 982-8502, Japan.
13
Department of Emergency Medicine, Kobe City Medical Center General Hospital, 2-2-1, Minatojima-minamimachi, Chuo-ku, Kobe-city, Hyogo, 650-0047, Japan.
14
Department of Emergency and Critical Care Medicine, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto-shi, Kyoto, 612-0861, Japan.
15
Department of Emergency Medicine, Fukuoka City Hospital, 1-13, Yoshizuka-honmachi, Hakata-ku, Fukuoka-shi, Fukuoka, 812-0046, Japan.
16
Shock and Trauma Center, Chiba-Hokusoh Hospital, Nippon Medical School, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan.
17
Department of Anesthesiology, Okayama Medical Center, 1711-1, Taeki, Kita-ku, Okayama-shi, Okayama, 701-1192, Japan.
18
Department of Intensive Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32, Toudaijima, Urayasu-shi, Chiba, 279-0001, Japan.
19
Division of Infectious Diseases and Infection Control, Tohoku Medical and Pharmaceutical University Hospital, 1-12-1, Fukumuro, Miyagino-ku, Sendai, 983-8512, Japan.
20
Department of Acute Care and General Medicine, Saiseikai Kumamoto Hospital, 5-3-1, Chikami, Minami-ku, Kumamoto-shi, Kumamoto, 861-4193, Japan.
21
Department of Central Laboratory and Infection Control, Takarazuka City Hospital, 4-5-1, Kohama, Takarazuka-shi, Hyogo, 665-0827, Japan.
22
Department of Surgery, Jichi Medical University, 3311-1, Yakushiji, Simono-shi, Tochigi, 329-0498, Japan.

Abstract

BACKGROUND:

To compare the efficacy of three antiseptic solutions [0.5%, and 1.0% alcohol/chlorhexidine gluconate (CHG), and 10% aqueous povidone-iodine (PVI)] for the prevention of intravascular catheter colonization, we conducted a randomized controlled trial in patients from 16 intensive care units in Japan.

METHODS:

Adult patients undergoing central venous or arterial catheter insertions were randomized to have one of three antiseptic solutions applied during catheter insertion and dressing changes. The primary endpoint was the incidence of catheter colonization, and the secondary endpoint was the incidence of catheter-related bloodstream infections (CRBSI).

RESULTS:

Of 1132 catheters randomized, 796 (70%) were included in the full analysis set. Catheter-tip colonization incidence was 3.7, 3.9, and 10.5 events per 1000 catheter-days in 0.5% CHG, 1% CHG, and PVI groups, respectively (p = 0.03). Pairwise comparisons of catheter colonization between groups showed a significantly higher catheter colonization risk in the PVI group (0.5% CHG vs. PVI: hazard ratio, HR 0.33 [95% confidence interval, CI 0.12-0.95], p = 0.04; 1.0% CHG vs. PVI: HR 0.35 [95% CI 0.13-0.93], p = 0.04). Sensitivity analyses including all patients by multiple imputations showed consistent quantitative conclusions (0.5% CHG vs. PVI: HR 0.34, p = 0.03; 1.0% CHG vs. PVI: HR 0.35, p = 0.04). No significant differences were observed in the incidence of CRBSI between groups.

CONCLUSIONS:

Both 0.5% and 1.0% alcohol CHG are superior to 10% aqueous PVI for the prevention of intravascular catheter colonization.

TRIAL REGISTRATION:

Japanese Primary Registries Network; No.: UMIN000008725 Registered on 1 September 2012.

KEYWORDS:

Anti-bacterial agents; Anti-infective agents; Catheter-related infections; Catheters; Chlorhexidine; Local; Povidone-iodine

PMID:
29268759
PMCID:
PMC5740719
DOI:
10.1186/s13054-017-1890-z
[Indexed for MEDLINE]
Free PMC Article

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