Doit-on utiliser la décontamination cutanée par la chlorhexidine en réanimation ?

Abstract

Prevention of health care-associated infection is a major concern in the intensive care unit. Bacterial skin colonization often precedes occurrence of these infections, especially infections related to staphylococcus species. Chlorhexidine is a topical bactericidal antiseptic with a good antimicrobial activity against Gram positive cocci, fungi but a limited activity against Gram negative rods. Daily chlorhexidine bathing may reduce the occurrence of nosocomial infection by decreasing skin bacterial load. The first observational studies have reported a decrease in skin colonization with staphylococcal or enterococcal species. A decrease in the rate of catheter-related bacteremia and primitive bacteremia has been also described. Multicenter randomized studies have reported a lower incidence of bacteremia caused by coagulase-negative staphylococci. Chlorhexidine bathing was not associated with a lower occurrence of ventilator-associated pneumonia and nosocomial urinary tract infections. This procedure was not associated with a lower incidence of infections caused by Gram negative bacilli. If the use of chlorhexidine bathing for a few months was not associated with acquisition of resistance, increase in the minimal inhibitory concentrations has been described for staphylococci. Daily chlorhexidine bathing could be recommended in units where incidence of staphylococcal blood stream infections remains high.