title: Effect of daily chlorhexidine bathing on acquisition of carbapenem-resistant Acinetobacter baumannii (CRAB) in the medical intensive care unit with CRAB endemicity.
abstract: BACKGROUND
  There is insufficient evidence for daily chlorhexidine bathing to reduce nosocomial spread of carbapenem-resistant Acinetobacter baumannii (CRAB) in endemic situations.
  
  
  METHODS
  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.
  
  
  RESULTS
  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, -0.904 to -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.
  
  
  CONCLUSIONS
  Daily chlorhexidine bathing significantly reduces the acquisition of CRAB in a medical ICU with CRAB endemicity.
authors: Department of Occupational and Environmental Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea.
authors: Yun Kyung
authors: YK
authors: Chung
authors: Department of Laboratory Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea.
authors: Jae-Seok
authors: JS
authors: Kim
authors: Division of Infectious Diseases, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea. Electronic address: hushh93@hallym.or.kr.
authors: Seung Soon
authors: SS
authors: Lee
authors: Division of Infectious Diseases, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea.
authors: Jeong-A
authors: JA
authors: Lee
authors: Department of Laboratory Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea.
authors: Han-Sung
authors: HS
authors: Kim
authors: Department of Occupational and Environmental Medicine, Seegene Medical Foundation, Seoul, South Korea.
authors: Kyong-Sok
authors: KS
authors: Shin
authors: Department of Laboratory Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea.
authors: Eun Young
authors: EY
authors: Park
authors: Medical Intensive Care Unit, Hallym University Sacred Heart Hospital, Anyang, South Korea.
authors: Bog Soun
authors: BS
authors: Kang
authors: Medical Intensive Care Unit, Hallym University Sacred Heart Hospital, Anyang, South Korea.
authors: Hee Jung
authors: HJ
authors: Lee
authors: Department of Infection Control, Hallym University Sacred Heart Hospital, Anyang, South Korea.
authors: Hyun Joo
authors: HJ
authors: Kang
mesh_terms: D000151:Acinetobacter Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D040981:Acinetobacter baumannii / Q000187:drug effects / Q000302:isolation & purification*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001494:Baths / Q000379:methods*; D015780:Carbapenems / Q000494:pharmacology*; D002710:Chlorhexidine / Q000008:administration & dosage* / Q000494:pharmacology; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D004202:Disinfectants / Q000008:administration & dosage* / Q000494:pharmacology; D004203:Disinfection / Q000379:methods*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D065186:Interrupted Time Series Analysis; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D065228:Non-Randomized Controlled Trials as Topic; D015995:Prevalence; D012189:Retrospective Studies; D055815:Young Adult; D018440:beta-Lactam Resistance
chemical_list: D015780:Carbapenems; D004202:Disinfectants; D002710:Chlorhexidine
keywords: Acinetobacter baumannii; Baths; Chlorhexidine gluconate; Drug resistance; Intensive care units; bacterial