Effect of daily chlorhexidine bathing on acquisition of carbapenem-resistant Acinetobacter baumannii (CRAB) in the medical intensive care unit with CRAB endemicity

Abstract

There is insufficient evidence for daily chlorhexidine bathing to reduce nosocomial spread of carbapenem-resistant Acinetobacter baumannii (CRAB) in endemic situations. An interrupted time series study was performed to evaluate the effect of daily chlorhexidine bathing on the acquisition of CRAB in a medical intensive care unit (ICU) with CRAB endemicity. There was a 14-month control period and 12-month chlorhexidine bathing period. Segmented Poisson regression analysis was performed to assess the impact of chlorhexidine bathing on the level and trend of the series of prevalence rates and incidence density. Also, chlorhexidine susceptibility testing was performed on CRAB isolates collected during the chlorhexidine bathing period. There was a 51.8% reduction of CRAB acquisition rates after an introduction of daily chlorhexidine bathing (44.0 vs 21.2 cases/1,000 at-risk patient days, P<.001). There was a significant reduction in the level (-0.604; 95% CI,-0.904to-0.305; P<.001) of incidence density of CRAB, whereas there was no significant change in both level and trend of CRAB prevalence rates. Minimum inhibitory concentration of chlorhexidine against a total of 98 CRAB isolates ranged from 8-64 μg/mL. Daily chlorhexidine bathing significantly reduces the acquisition of CRAB in a medical ICU with CRAB endemicity.