title: Chlorhexidine-based antiseptic solutions effectively reduce catheter-related bacteremia.
abstract: The aim of this retrospective study was to investigate if the application of chlorhexidine-based solutions (ChloraPrep) to the exit site and the hub of long-term hemodialysis catheters could prevent catheter-related bacteremia (CRB) and prolong catheter survival when compared with povidone-iodine solutions. There were 20,784 catheter days observed. Povidone-iodine solutions (Betadine) were used in the first half of the study and ChloraPrep was used in the second half for all the patients. Both groups received chlorhexidine-impregnated dressings at the exit sites. The use of ChloraPrep significantly decreased the incidence of CRB (1.0 vs 2.2/1,000 catheter days, respectively, P = 0.0415), and hospitalization due to CRB (1.8 days vs 4.1 days/1,000 catheter days, respectively, P = 0.0416). The incidence of exit site infection was similar for the two groups. Both the period of overall catheter survival (207.6 days vs 161.1 days, P = 0.0535) and that of infection-free catheter survival (122.0 days vs 106.9 days, P = 0.1100) tended to be longer for the catheters cleansed with ChloraPrep, with no statistical significance. In conclusion, chlorhexidine-based solutions are more effective for the prevention of CRB than povidone-iodine solutions. This positive impact cannot be explained by decreased number of exit site infections. This study supports the notion that the catheter hub is the entry site for CRB.
authors.affiliation: Department of Pediatrics, Division of Pediatric Nephrology, School of Medicine, West Virginia University/Health Sciences Center, Morgantown, WV 26506, USA. aonder@hsc.wvu.edu
authors.forename: Ali Mirza
authors.initials: AM
authors.lastname: Onder
authors.forename: Jayanthi
authors.initials: J
authors.lastname: Chandar
authors.forename: Anthony
authors.initials: A
authors.lastname: Billings
authors.forename: Rosa
authors.initials: R
authors.lastname: Diaz
authors.forename: Denise
authors.initials: D
authors.lastname: Francoeur
authors.forename: Carolyn
authors.initials: C
authors.lastname: Abitbol
authors.forename: Gaston
authors.initials: G
authors.lastname: Zilleruelo
mesh_terms: D000293:Adolescent; D016470:Bacteremia / Q000517:prevention & control*; D055499:Catheter-Related Infections / Q000209:etiology / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D002710:Chlorhexidine / Q000494:pharmacology*; D004202:Disinfectants / Q000494:pharmacology*; D004866:Equipment Contamination / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D004202:Disinfectants; D002710:Chlorhexidine