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

Roethlisberger, Michel and Moffa, Giusi and Fisch, Urs and Wiggli, Benedikt and Schoen, Stephan and Kelly, Christopher and Leu, Severina and Croci, Davide and Zumofen, Daniel W. and Cueni, Nadine and Nogarth, Danica and Schulz, Marianne and Bucher, Heiner C. and Weisser-Rohacek, Maja and Wasner, Morten-Goetz and Widmer, Andreas F. and Mariani, Luigi. (2018) Effectiveness of a chlorhexidine dressing on silver-coated external ventricular drain associated colonization/infection - a prospective single-blinded randomized controlled clinical trial (EVDAI-Study). Clinical Infectious Diseases, 67 (12). pp. 1868-1877.

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Official URL: https://edoc.unibas.ch/67932/

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Abstract

Observational 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.; In 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.; From 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).; Our data support the use of CHX dressings to reduce EVD exit site contamination, potentially reducing EVDAIs and permanent cerebrospinal fluid diversion procedures for hydrocephalus.; NCT02078830.
Faculties and Departments:09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH)
UniBasel Contributors:Weisser, Maja
Item Type:Article, refereed
Article Subtype:Research Article
Publisher:Oxford University Press
ISSN:1058-4838
e-ISSN:1537-6591
Note:Publication type according to Uni Basel Research Database: Journal article
Identification Number:
Last Modified:15 Jan 2019 14:35
Deposited On:15 Jan 2019 14:35

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