Effectiveness of a Chlorhexidine Dressing on Silver-coated External Ventricular Drain–associated Colonization and Infection: A Prospective Single-blinded Randomized Controlled Clinical Trial

Clinical Infectious Diseases 2018: ciy393-ciy393 (Journal)

Roethlisberger Michel, Moffa Giusi, Fisch Urs, Wiggli Benedikt, Schoen Stephan, Kelly Christopher, Leu Severina, Croci Davide, Zumofen Daniel W., Cueni Nadine, Nogarth Danica, Schulz Marianne, Bucher Heiner C., Weisser-Rohacek Maja, Wasner Morten-Goetz, Widmer Andreas F., Mariani Luigi

BackgroundObservational studies have shown that dressings containing chlorhexidine gluconate (CHX) lower the incidence external ventricular drain (EVD)–associated infections (EVDAIs). This prospective, randomized controlled trial (RCT) studies the efficacy of CHX-containing dressings in reducing bacterial colonization.MethodsIn this RCT, patients aged ≥18 years undergoing emergency EVD placement were randomly given either a CHX-containing or an otherwise identical control dressing at the skin exit wound. The primary end-point was bacterial regrowth in cultured skin swab samples of the EVD exit wound. The secondary end-points were catheters processed by sonication, clinically diagnosed EVDAI and surgical treatment of hydrocephalus.ResultsFrom October 2013 to January 2016, a total of 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 (geometric mean ratio, 0.18; 95% confidence interval, .08–.42; P < .001). The incidence of colonized catheters was lower in the CHX group (5 of 28; 18%) than in the control group (10 of 27; 33%), with less microbial colonization on the subcutaneous portion. The infection rate was 4 of 28 (14%) in the CHX group, compared with 7 of 27 (26%) in the control group, with a substantially lower hydrocephalus treatment rate (7 of 28 [25%] vs 14 of 27 [52%], respectively).ConclusionOur data support the use of CHX dressings to reduce EVD exit site contamination, potentially reducing EVDAIs and permanent cerebrospinal fluid diversion procedures for hydrocephalus.

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