Effect of Chlorhexidine Whole-Body Bathing on Hospital-Acquired Infections Among Trauma Patients

Evans, Heather L.; Dellit, Timothy H.; Chan, Jeannie D.; Nathens, Avery B.; Maier, Ronald V.; Cuschieri, Joseph

doi:10.1001/archsurg.2010.5

Cited by 125 publications

(95 citation statements)

References 37 publications

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“…Furthermore, these antimicrobials are not effective because bacteria in biofilms can be up to 1,000-fold less sensitive to antibiotics than their planktonic counterparts (10)(11)(12). Other topical disinfectants, such as chlorhexidine (13), silver sulfadiazine (14), and iodine preparations (15), can be very painful when applied to open wounds (16), and the scientific evidence for the efficacy of these agents in wounds is scarce. Clearly, there is an urgent need for novel antimicrobial agents that can be applied topically to (i) prevent colonization and (ii) eliminate infectious agents in burn wounds (17).…”

mentioning

confidence: 99%

LL-37-Derived Peptides Eradicate Multidrug-Resistant Staphylococcus aureus from Thermally Wounded Human Skin Equivalents

Haisma

Breij

Chan

et al. 2014

Antimicrob Agents Chemother

122

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Burn wound infections are often difficult to treat due to the presence of multidrug-resistant bacterial strains and biofilms. Currently, mupirocin is used to eradicate methicillin-resistant Staphylococcus aureus (MRSA) from colonized persons; however, mupirocin resistance is also emerging. Since we consider antimicrobial peptides to be promising candidates for the development of novel anti-infective agents, we studied the antibacterial activities of a set of synthetic peptides against different strains of S. aureus, including mupirocin-resistant MRSA strains. The peptides were derived from P60.4Ac, a peptide based on the human cathelicidin LL-37. The results showed that peptide 10 (P10) was the only peptide more efficient than P60.4Ac, which is better than LL-37, in killing MRSA strain LUH14616. All three peptides displayed good antibiofilm activities. However, both P10 and P60.4Ac were more efficient than LL-37 in eliminating biofilm-associated bacteria. No toxic effects of these three peptides on human epidermal models were detected, as observed morphologically and by staining for mitochondrial activity. In addition, P60.4Ac and P10, but not LL-37, eradicated MRSA LUH14616 and the mupirocin-resistant MRSA strain LUH15051 from thermally wounded human skin equivalents (HSE). Interestingly, P60.4Ac and P10, but not mupirocin, eradicated LUH15051 from the HSEs. None of the peptides affected the excretion of interleukin 8 (IL-8) by thermally wounded HSEs upon MRSA exposure. In conclusion, the synthetic peptides P60.4Ac and P10 appear to be attractive candidates for the development of novel local therapies to treat patients with burn wounds infected with multidrug-resistant bacteria.

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confidence: 99%

LL-37-Derived Peptides Eradicate Multidrug-Resistant Staphylococcus aureus from Thermally Wounded Human Skin Equivalents

Haisma

Breij

Chan

et al. 2014

Antimicrob Agents Chemother

122

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“…Although it has been used for decades in various roles, ranging from hand washing to preoperative skin preparation, chlorhexidine has been increasingly employed for the prevention of both nosocomial (21)(22)(23)(24) and community-associated infections (2,(25)(26)(27). Evidence from large randomized-control trials points to the importance of chlorhexidine in the prevention of the spread of drugresistant organisms and hospital-acquired infections (21,24,28).…”

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confidence: 99%

Recurrent Methicillin-Resistant Staphylococcus aureus Cutaneous Abscesses and Selection of Reduced Chlorhexidine Susceptibility during Chlorhexidine Use

et al. 2015

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“…This is of importance, as A. baumannii is able to colonize the skin (2,7,8,17,24), which can be a source of infection and spread to other patients and the environment. Recent papers have emphasized the benefits of skin disinfection as a tool to reduce colonization pressure in a ward (2,12,22). Our main conclusion is based on the following findings.…”

Section: Discussionmentioning

confidence: 79%

Three-Dimensional Human Skin Equivalent as a Tool To Study Acinetobacter baumannii Colonization

Breij

Haisma

Rietveld

et al. 2012

Antimicrob Agents Chemother

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bAcinetobacter baumannii can colonize body surfaces of hospitalized patients. From these sites, invasion into the host and spread to other patients and the hospital environment may occur. The eradication of the organism from the patient's skin is an important infection control strategy during epidemic and endemic episodes. In this study, a three-dimensional (3D), air-exposed human epidermal skin equivalent was exploited to study Acinetobacter skin colonization. We characterized the adherence of A. baumannii ATCC 19606T and Acinetobacter junii RUH2228 T to and biofilm formation on the skin equivalent and the responses to these bacteria. Furthermore, we assessed the ability of the disinfectant chlorhexidine to decolonize the skin equivalents. The results revealed that both strains replicated on the stratum corneum for up to 72 h but did not invade the epidermis. A. baumannii, in contrast to A. junii, formed large biofilms on the stratum corneum. Bacterial colonization did not affect keratinocyte activation, proliferation, or differentiation, nor did it induce a strong inflammatory response. Disinfection with chlorhexidine solution resulted in complete eradication of A. baumannii from the skin, without detrimental effects. This 3D model is a promising tool to study skin colonization and to evaluate the effects of novel disinfectant and antimicrobial strategies. Multidrug-resistant (MDR) strains of Acinetobacter baumannii are notorious for their association with outbreaks of colonization and infection worldwide (6, 23). During such outbreaks, A. baumannii can colonize body surfaces of severely ill patients, from where the organisms may invade the patient, causing infection and/or spread to other patients and their environment. Thus, the skin is thought to constitute an important reservoir for A. baumannii during outbreaks and endemic episodes (1, 17). Insight into Acinetobacter skin colonization and the microbial ecology of the skin may result in novel strategies to prevent or interfere with skin colonization and thus contribute to the eradication of the organisms from a ward.Adherence to and biofilm formation on plastic and adherence to human cells are widely used systems to study the interactions of bacteria with abiotic and biotic surfaces. However, these systems may not adequately reflect the association of bacteria with the human skin, a process that takes place under relatively dry conditions (20). Moreover, adherence and subsequent replication are strongly influenced by environmental conditions (19), which in turn can be expected to depend on the physicochemical barrier properties of the skin surface and its nutrient availability. Once bacteria have adhered to the skin, they may invade the epidermis and trigger an inflammatory response. To our knowledge, little is known about the possible response of human skin cells to Acinetobacter.Tissue-engineered, air-exposed human skin models are threedimensional (3D) systems that mimic the native skin to a high degree (10, 11). Such epidermal skin equivalents are gener...

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Effect of Chlorhexidine Whole-Body Bathing on Hospital-Acquired Infections Among Trauma Patients

Abstract: Daily bathing of trauma patients with cloths impregnated with 2% chlorhexidine gluconate is associated with a decreased rate of colonization by MRSA and Acinetobacter and lower rates of catheter-related bloodstream infection and MRSA VAP.

Cited by 125 publications

References 37 publications

LL-37-Derived Peptides Eradicate Multidrug-Resistant Staphylococcus aureus from Thermally Wounded Human Skin Equivalents

LL-37-Derived Peptides Eradicate Multidrug-Resistant Staphylococcus aureus from Thermally Wounded Human Skin Equivalents

Recurrent Methicillin-Resistant Staphylococcus aureus Cutaneous Abscesses and Selection of Reduced Chlorhexidine Susceptibility during Chlorhexidine Use

Three-Dimensional Human Skin Equivalent as a Tool To Study Acinetobacter baumannii Colonization

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