TY - JOUR
T1 - Impact of Chlorhexidine Bathing on Antimicrobial Utilization in Surgical Intensive Care Unit
AU - Bui, Lan N.
AU - Swan, Joshua T.
AU - Perez, Katherine K.
AU - Johnson, Michael L.
AU - Chen, Hua
AU - Colavecchia, A. Carmine
AU - Rizk, Elsie
AU - Graviss, Edward A.
N1 - Funding Information:
The investigators thank the Department of Pharmacy at Houston Methodist Hospital and the Center for Outcomes Research at Houston Methodist Research Institute for providing administrative, intellectual, and information technology support. Authors' contributions: L.N.B. served as the lead investigator on study design, data collection, data analysis, and interpretation of the findings. J.T.S. was the principal investigator on the institutional review board protocol of the original CHG-BATH trial, developed the study database, and was involved with interpretation of all analyses. L.N.B. J.T.S. K.K.P. H.C. M.L.J. A.C.C. E.R. and E.A.G. assisted with the study design and evaluation of the data. All authors had full access to all the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis. L.N.B. wrote the first draft of the manuscript. All authors revised the protocol and the manuscript for intellectual content and approved the final version of the manuscript.
Funding Information:
L.N.B. received a fellowship from Texas Southern University in 2012 supporting her effort on the CHG-BATH trial. J.T.S. received an intramural grant from Houston Methodist Research Institute to support the CHG-BATH trial. The authors reported no proprietary or commercial interest in any product mentioned or concept discussed in this article. This secondary analysis did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Publisher Copyright:
© 2020 Elsevier Inc.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/6
Y1 - 2020/6
N2 - Background: This secondary analysis compared antimicrobial utilization among surgical intensive care unit patients randomized to every other day chlorhexidine bathing (chlorhexidine) versus daily soap and water bathing (soap-and-water) using data from the CHlorhexidine Gluconate BATHing trial. Materials and methods: Antimicrobial utilization was quantified using defined daily dose (DDD)/100 patient-days and agent-days/100 patient-days for systemic antimicrobials. Antivirals (except oseltamivir), antiparasitics, and prophylaxis agents were excluded. The 2018 anatomic therapeutic chemical/DDD index was used to calculate DDD. Agent-days were calculated as the sum of calendar days where antimicrobials were administered. Patient-days were defined as time patients were at risk for health care–acquired infections plus up to 14 d. Primary analyses were conducted using linear regression adjusted for baseline Acute Physiology and Chronic Health Evaluation II scores. Results: Of 325 CHlorhexidine Gluconate BATHing trial patients, 312 (157 in soap-and-water and 155 in chlorhexidine) were included. The median (interquartile range) of total antimicrobial DDD/100 patient-days was 135.4 (75.2-231.8) for soap-and-water and 129.9 (49.2-215.3) for chlorhexidine. The median (interquartile range) of total antimicrobial agent-days/100 patient-days was 155.6 (83.3-243.2) for soap-and-water and 146.7 (66.7-217.4) for chlorhexidine. After adjusting for Acute Physiology and Chronic Health Evaluation II scores, chlorhexidine bathing was associated with a nonsignificant reduction in total antimicrobial DDD/100 patient-days (−3.9; 95% confidence interval, −33.9 to 26.1; P = 0.80) and total antimicrobial agent-days/100 patient-days (−10.3; 95% confidence interval, −34.7 to 14.1; P = 0.41). Conclusions: Compared with daily soap and water bathing, every other day chlorhexidine bathing did not significantly reduce total antimicrobial utilization in surgical intensive care unit patients.
AB - Background: This secondary analysis compared antimicrobial utilization among surgical intensive care unit patients randomized to every other day chlorhexidine bathing (chlorhexidine) versus daily soap and water bathing (soap-and-water) using data from the CHlorhexidine Gluconate BATHing trial. Materials and methods: Antimicrobial utilization was quantified using defined daily dose (DDD)/100 patient-days and agent-days/100 patient-days for systemic antimicrobials. Antivirals (except oseltamivir), antiparasitics, and prophylaxis agents were excluded. The 2018 anatomic therapeutic chemical/DDD index was used to calculate DDD. Agent-days were calculated as the sum of calendar days where antimicrobials were administered. Patient-days were defined as time patients were at risk for health care–acquired infections plus up to 14 d. Primary analyses were conducted using linear regression adjusted for baseline Acute Physiology and Chronic Health Evaluation II scores. Results: Of 325 CHlorhexidine Gluconate BATHing trial patients, 312 (157 in soap-and-water and 155 in chlorhexidine) were included. The median (interquartile range) of total antimicrobial DDD/100 patient-days was 135.4 (75.2-231.8) for soap-and-water and 129.9 (49.2-215.3) for chlorhexidine. The median (interquartile range) of total antimicrobial agent-days/100 patient-days was 155.6 (83.3-243.2) for soap-and-water and 146.7 (66.7-217.4) for chlorhexidine. After adjusting for Acute Physiology and Chronic Health Evaluation II scores, chlorhexidine bathing was associated with a nonsignificant reduction in total antimicrobial DDD/100 patient-days (−3.9; 95% confidence interval, −33.9 to 26.1; P = 0.80) and total antimicrobial agent-days/100 patient-days (−10.3; 95% confidence interval, −34.7 to 14.1; P = 0.41). Conclusions: Compared with daily soap and water bathing, every other day chlorhexidine bathing did not significantly reduce total antimicrobial utilization in surgical intensive care unit patients.
KW - Agent day
KW - Antimicrobial utilization
KW - Chlorhexidine bathing
KW - Defined daily dose
KW - Health care–acquired infections
KW - Surgical intensive care unit
KW - Humans
KW - Middle Aged
KW - Chlorhexidine/administration & dosage
KW - Male
KW - Drug Utilization/statistics & numerical data
KW - Critical Care/methods
KW - Intensive Care Units/statistics & numerical data
KW - Anti-Infective Agents, Local/administration & dosage
KW - Baths/methods
KW - Cross Infection/drug therapy
KW - Soaps/administration & dosage
KW - Adult
KW - Female
KW - Aged
KW - Anti-Bacterial Agents/therapeutic use
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U2 - 10.1016/j.jss.2019.12.049
DO - 10.1016/j.jss.2019.12.049
M3 - Article
C2 - 32065967
AN - SCOPUS:85079430270
SN - 0022-4804
VL - 250
SP - 161
EP - 171
JO - Journal of Surgical Research
JF - Journal of Surgical Research
ER -