Trial reportSeminars in dialysis
Antimicrobial Glucose Chlorhexidine Dressings vs. Sterile Dressings in Preventing Catheter-Related Infections During Continuous Renal Replacement Therapy: A Randomized Controlled Trial.
Trial report in Seminars in dialysis. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundCatheter-related bloodstream infections (CRBSIs) are a major cause of complications in critically ill patients receiving continuous renal replacement therapy (CRRT), especially those with nontunneled catheters. These infections can lead to longer hospital stays, higher costs, and worse patient outcomes. Although sterile dressings are commonly used to prevent CRBSIs, antimicrobial dressings, such as those containing chlorhexidine, may offer better protection. This study aimed to compare the effectiveness of antimicrobial glucose chlorhexidine dressings and sterile dressings in preventing CRBSIs in patients receiving CRRT.
methodsA prospective, randomized controlled, single-blind study was conducted. All participants were kept blinded to group assignment. We enrolled patients admitted to the Intensive Care Unit (ICU) of West China Hospital, Sichuan University between September 2022 and November 2023 who were scheduled for vascular catheter placement before receiving continuous renal replacement therapy (CRRT). The participants were randomly allocated to either the intervention group (receiving glucose chlorhexidine antimicrobial dressing) or the control group (receiving sterile dressing) via a random number table. The dressing was changed every 7 days for the glucose chlorhexidine antimicrobial group and every 48 h for the sterile dressing group, in accordance with the guideline. Dressings were replaced immediately if they became rolled, loose, or visibly soiled. The primary outcomes were the local infection rate at the catheter insertion site, suspected catheter-related bloodstream infections (CRBSIs), incidence of CRBSIs, length of hospital stay, ICU stay duration, and hospital mortality rates.
resultsA total of 520 patients were screened, and 410 patients were ultimately included in the study, with 205 patients in each group (glucose chlorhexidine antimicrobial dressing group and sterile dressing group). The incidence of local infection at the catheter insertion site was 40.0% in the sterile dressing group, which was significantly greater than the 15.6% reported in the glucose chlorhexidine antimicrobial dressing group (p < 0.001). The total CRBSI rate in the intervention group was significantly lower (6.3%) than that in the control group (13.7%) (p = 0.014). No significant differences were found between the two groups in terms of suspected catheter-related bloodstream infections (CRBSIs), CRBSI incidence, length of hospital stay, ICU stay duration, or hospital mortality rates (p > 0.05). The Cox proportional hazards model suggested that patients in the control group were at a substantially greater risk of local infections and CRBSIs over time than those in the intervention group.
conclusionGlucose chlorhexidine antimicrobial dressings significantly reduce catheter insertion site infections and overall CRBSI incidence, demonstrating their clinical value in preventing infection in patients receiving CRRT.
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