RESUMEN
BACKGROUND: Results of previous single-center, observational studies suggest that daily bathing of patients with chlorhexidine may prevent hospital-acquired bloodstream infections and the acquisition of multidrug-resistant organisms (MDROs). METHODS: We conducted a multicenter, cluster-randomized, nonblinded crossover trial to evaluate the effect of daily bathing with chlorhexidine-impregnated washcloths on the acquisition of MDROs and the incidence of hospital-acquired bloodstream infections. Nine intensive care and bone marrow transplantation units in six hospitals were randomly assigned to bathe patients either with no-rinse 2% chlorhexidine-impregnated washcloths or with nonantimicrobial washcloths for a 6-month period, exchanged for the alternate product during the subsequent 6 months. The incidence rates of acquisition of MDROs and the rates of hospital-acquired bloodstream infections were compared between the two periods by means of Poisson regression analysis. RESULTS: A total of 7727 patients were enrolled during the study. The overall rate of MDRO acquisition was 5.10 cases per 1000 patient-days with chlorhexidine bathing versus 6.60 cases per 1000 patient-days with nonantimicrobial washcloths (P=0.03), the equivalent of a 23% lower rate with chlorhexidine bathing. The overall rate of hospital-acquired bloodstream infections was 4.78 cases per 1000 patient-days with chlorhexidine bathing versus 6.60 cases per 1000 patient-days with nonantimicrobial washcloths (P=0.007), a 28% lower rate with chlorhexidine-impregnated washcloths. No serious skin reactions were noted during either study period. CONCLUSIONS: Daily bathing with chlorhexidine-impregnated washcloths significantly reduced the risks of acquisition of MDROs and development of hospital-acquired bloodstream infections. (Funded by the Centers for Disease Control and Prevention and Sage Products; ClinicalTrials.gov number, NCT00502476.).
Asunto(s)
Antiinfecciosos Locales/uso terapéutico , Bacteriemia/prevención & control , Baños , Clorhexidina/uso terapéutico , Infección Hospitalaria/prevención & control , Farmacorresistencia Bacteriana Múltiple , Bacteriemia/epidemiología , Bacteriemia/microbiología , Infección Hospitalaria/epidemiología , Estudios Cruzados , Enterococcus/efectos de los fármacos , Enterococcus/aislamiento & purificación , Infecciones por Bacterias Grampositivas/prevención & control , Humanos , Incidencia , Unidades de Cuidados Intensivos , Estimación de Kaplan-Meier , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Modelos de Riesgos Proporcionales , Infecciones Estafilocócicas/prevención & control , Resistencia a la VancomicinaAsunto(s)
Cafeína/efectos adversos , Estimulantes del Sistema Nervioso Central/efectos adversos , Bebidas Energéticas/efectos adversos , Cafeína/farmacocinética , Cafeína/envenenamiento , Causas de Muerte , Estimulantes del Sistema Nervioso Central/farmacocinética , Estimulantes del Sistema Nervioso Central/envenenamiento , Suplementos Dietéticos , Humanos , Masculino , Mortalidad/tendencias , Mal Uso de Medicamentos de Venta con Receta , Etiquetado de Productos , Estados Unidos/epidemiología , United States Food and Drug AdministrationRESUMEN
Recent surveillance from US hospitals shows that more than 99.5% of vancomycin-resistant enterococci (VRE) isolates remain susceptible to daptomycin. This report describes emergence of daptomycin-resistant VRE at a major cancer center. The percentage of patients with daptomycin-resistant VRE bacteremia increased from 3.4% in 2007 to 15.2% in 2009 ([Formula: see text]). Without susceptibility data, empiric daptomycin therapy for VRE infections should be used with caution.
Asunto(s)
Antibacterianos/uso terapéutico , Daptomicina/uso terapéutico , Farmacorresistencia Bacteriana Múltiple , Enterococcus faecium/efectos de los fármacos , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Bacteriemia/complicaciones , Bacteriemia/tratamiento farmacológico , Niño , Enterococcus faecium/aislamiento & purificación , Femenino , Infecciones por Bacterias Grampositivas/complicaciones , Infecciones por Bacterias Grampositivas/microbiología , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Neoplasias/complicaciones , Resistencia a la VancomicinaRESUMEN
Echinocandins are a novel class of antifungal drugs that target beta (1, 3)-D-glucan synthesis. Animal studies have shown that these agents have activity against Pneumocystis jiroveci infection; however, clinical data are lacking. We reviewed all cases of proven P. jiroveci pneumonia (PCP) in non-human immunodeficiency virus-infected patients at our hospital over a 5 year period (2001-2005). Two patients received conventional PCP treatment and concomitant use of echinocandins for presumed invasive aspergillus. In both cases, PCP progressed, and the patient died. The use of echinocandins in the prevention or treatment of PCP cannot be recommended without evidence to support their effectiveness.