Effectiveness of a chlorhexidine dressing on silver-coated external ventricular drain associated colonization/infection - a prospective single-blinded randomized controlled clinical trial (EVDAI-Study)

Clin Infect Dis 2018: , ISBN 1537-6591 (Electronic)
1058-4838 (Linking) (Journal)

Roethlisberger M., Moffa G., Fisch U., Wiggli B., Schoen S., Kelly C., Leu S., Croci D., Zumofen D. W., Cueni N., Nogarth D., Schulz M., Bucher H. C., Weisser-Rohacek M., Wasner M. G., Widmer A. F., Mariani L.

Background: Observational studies have shown that dressings containing chlorhexidine gluconate (CHX) lower the incidence external ventricular drain (EVD) associated infections (EVDAI). This prospective, randomized controlled trial (RCT) studies the efficacy of CHX-containing dressings in reducing bacterial colonization, which represents an important risk factor for infectious complications. Methods: In this single-site, prospective, double-blinded RCT, patients aged >/=18 undergoing emergency EVD placement were randomly given either a CHX- or an otherwise identical control dressing at the skin exit wound of the EVD. The primary endpoint was bacterial regrowth in cultured skin swabs of the EVD exit wound before dressing application and after 5 days. Catheters were processed by sonication. The secondary endpoints were clinically diagnosed EVDAI and surgical treatment of hydrocephalus. Results: From October 2013 to January 2016, 57 patients were randomized to receive either a CHX- or a control dressing (29 and 28 patients, respectively). Cutaneous bacterial regrowth at the EVD exit wound was significantly reduced over time (OR 0.18, 95% CI 0.08, 0.42, p</=.0001). The incidence of colonized catheters was lower in the CHX- (5/28 [18%]) compared to the control group (10/27 [33%]) with less microbial colonization on the subcutaneous portion (0.22 [0.04, 1.07] p=.059). The infection rate was 4/28 (14%) in the CHX- compared to 7/27 (26%) in the control group with a substantially lower hydrocephalus treatment rate (7/28 [25%] and 14/27 [52%]) respectively. Conclusion: Our data support the use of CHX dressings to reduce EVD exit site contamination, potentially EVDAI and permanent cerebrospinal fluid diversion procedures for hydrocephalus.

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