Relationship between chlorhexidine gluconate concentration and microbial colonization of patients’ skin

Details

• Alternative Title:
  Infect Control Hosp Epidemiol
• Personal Author:
  Rhee, Yoona ; Simms, Andrew T. ; Schoeny, Michael ; Baker, Arthur W. ; Baker, Meghan A. ; Gohil, Shruti ; Rhee, Chanu ; Talati, Naasha J. ; Warren, David K. ; Welbel, Sharon ; Lolans, Karen ; Bell, Pamela B. ; Fukuda, Christine ; Hayden, Mary K. ; Lin, Michael Y.
• Description:
  Objective:
  
  To characterize the relationship between chlorhexidine gluconate (CHG) skin concentration and skin microbial colonization.
  
  Design:
  
  Serial cross-sectional study.
  
  Setting/participants:
  
  Adult patients in medical intensive care units (ICUs) from 7 hospitals; from 1 hospital, additional patients colonized with carbapenemase-producing Enterobacterales (CPE) from both ICU and non-ICU settings. All hospitals performed routine CHG bathing in the ICU.
  
  Methods:
  
  Skin swab samples were collected from adjacent areas of the neck, axilla, and inguinal region for microbial culture and CHG skin concentration measurement using a semiquantitative colorimetric assay. We used linear mixed effects multilevel models to analyze the relationship between CHG concentration and microbial detection. We explored threshold effects using additional models.
  
  Results:
  
  We collected samples from 736 of 759 (97%) eligible ICU patients and 68 patients colonized with CPE. On skin, gram-positive bacteria were cultured most frequently (93% of patients), followed by Candida species (26%) and gram-negative bacteria (20%). The adjusted odds of microbial recovery for every twofold increase in CHG skin concentration were 0.84 (95% CI, 0.80–0.87; P < .001) for gram-positive bacteria, 0.93 (95% CI, 0.89–0.98; P = .008) for Candida species, 0.96 (95% CI, 0.91–1.02; P = .17) for gram-negative bacteria, and 0.94 (95% CI, 0.84–1.06; P = .33) for CPE. A threshold CHG skin concentration for reduced microbial detection was not observed.
  
  Conclusions:
  
  On a cross-sectional basis, higher CHG skin concentrations were associated with less detection of gram-positive bacteria and Candida species on the skin, but not gram-negative bacteria, including CPE. For infection prevention, targeting higher CHG skin concentrations may improve control of certain pathogens.
  
  
• Source:
  Infect Control Hosp Epidemiol. :1-6
• Pubmed ID:
  38804007
• Pubmed Central ID:
  PMC11705612
• Document Type:
  Journal Article
• Funding:
  U54 CK000481/CK/NCEZID CDC HHSUnited States/
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:381a620bf8c8b74ed9cf9db4f32d044a2215ab23a199ed511a690e5bb6d1c16bcea59e7e1a3156c2eebacddb7069891406ad9353df7cd2d0959e2a13a1ac93c7
• Download URL:
  https://stacks.cdc.gov/view/cdc/175432/cdc_175432_DS1.pdf
• File Type:
  [PDF - 428.25 KB ]