Effect of aqueous chlorhexidine on skin colonization with gram negative bacteria in preterm infants admitted in NICU: a blinded RCT

Abstract

Background: Aqueous chlorhexidine applied repeatedly may predispose to increased gram negative bacterial colonization in preterm skin due to its higher bactericidal action against gram positive bacteria and absence of alcohol. The objective was to study the difference in rates of gram negative bacterial colonization in skin swabs taken from axilla and groin on day 7 after multiple applications of 0.5% aqueous chlorhexidine and placebo (sterile water).Methods: Double blinded, randomised controlled trial recruiting preterm infants(28-34weeks) weighing ≥1000grams, stratified(28-31:32-34week) and randomly allocated to receive multiple body cleansing every 48hours starting from 6hours within birth during first postnatal week. Intervention group received cleansing with 0.5%chlorhexidine wipes and controls cleansed with similar looking sterile water wipes. Comparison of Proportions of swabs showing Gram negative bacterial growth in swabs taken from axilla and groin on day 7 of life after 3 cleansings (primary), at recruitment, 24 and 48 hours after first cleansing (secondary) were outcomes measured.Results: Of 137 eligible neonates, 120 enrolled and 59 infants received chlorhexidine cleansing and 61 received sterile water. At the end of first week, the rate of skin colonization with gram negative bacteria after multiple applications of 0.5% aqueous chlorhexidine was comparable with sterile water cleansing in both axilla (40.9% vs 51.1%, p=0.432) and groin (60.7% vs 54.3%, p=0.592). There was no difference in the rate of gram negative bacterial colonization in axilla and groin skin at 24 and 48 hours after single application also.Conclusions: Aqueous chlorhexidine even after multiple cleansings at 48hours intervals soon after birth has not predisposed to colonization with gram negative bacterial in preterm infants admitted in NICU.