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Chlorhexidine for the prevention of bloodstream infection associated with totally implantable venous ports in patients with solid cancers

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Abstract

Purpose

To evaluate the preventive effects of topical skin disinfection with chlorhexidine on bloodstream infection (BSI) associated with totally implantable venous port (Port-A).

Methods

Two consecutive cohorts of solid cancer patients were prospectively followed for the occurrence of Port-A associated BSI (PABSI). The first cohort used povidone–iodine as topical skin disinfection and the second cohort used chlorhexidine. The primary endpoint was the time to first PABSI. Propensity score analysis was applied. The preventive effects of chlorhexidine were analyzed by Cox proportional hazards models.

Results

There were 396 patients (81,752 catheter-days) in the iodine cohort and 497 (99,977 catheter-days) in the chlorhexidine cohort. Gram-negative bacteria were the most common pathogens to cause first episode of PABSI (iodine cohort (I) vs chlorhexidine cohort (C) and 0.404 vs 0.450 per 1,000 catheter-day), followed by Gram-positive bacteria (I vs C and 0.269 vs 0.110 per 1,000 catheter-day), and fungi (I vs C and 0.098 vs 0.070 per 1,000 catheter-day). Three hundred forty-three patients were selected from each cohort by propensity score match analysis. Chlorhexidine use was associated with a significant improvement on time to first PABSI caused by Gram-positive bacteria (log-rank test, p = 0.00175; HR = 0.35, 95 % CI, 0.14–0.85, p = 0.02). No significant preventive effects of chlorhexidine on time to first PABSI caused by Gram-negative bacteria or fungi was found.

Conclusions

Chlorhexidine topical skin disinfection may prevent PABSI caused by Gram-positive bacteria in patients with solid cancers. The nonsignificant effect on preventing overall PABSI may be attributed to the high incidence of Gram-negative bacteria related PABSI.

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Acknowledgments

This study was supported by grants NTUH-100-S1805 from the National Taiwan University Hospital and DOH100-TD-C-111-001 from the Department of Health, Taiwan.

Conflict of interest

None to declare

Author information

Authors and Affiliations

  1. Department of Oncology, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin, Taiwan

    Hsiang-Fong Kao

  2. Department of Oncology, National Taiwan University Hospital, No.7 Chung-Shan South Road, Zhongzheng District, Taipei, 10002, Taiwan

    Hsiang-Fong Kao, I-Chun Chen, Chiun Hsu, James Chih-Hsin Yang, Ann-Lii Cheng & Kun-Huei Yeh

  3. Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

    Chiun Hsu, Yee-Chun Chen & Ann-Lii Cheng

  4. Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan

    Sin-Yuan Chang & Shu-Fen Chien

  5. Center for Infection Control, National Taiwan University Hospital, Taipei, Taiwan

    Shu-Fen Chien & Yee-Chun Chen

  6. Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan

    Fu-Chang Hu

  7. School of Nursing, National Taiwan University College of Medicine, Taipei, Taiwan

    Fu-Chang Hu

  8. Graduate Institute of Oncology, National Taiwan University College of Medicine, No.7 Chung-Shan South Road, Zhongzheng District, Taipei, 10002, Taiwan

    James Chih-Hsin Yang, Ann-Lii Cheng & Kun-Huei Yeh

Authors
  1. Hsiang-Fong Kao
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  2. I-Chun Chen
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  3. Chiun Hsu
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  4. Sin-Yuan Chang
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  6. Yee-Chun Chen
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  9. Ann-Lii Cheng
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  10. Kun-Huei Yeh
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Corresponding author

Correspondence to Kun-Huei Yeh.

Additional information

Hsiang-Fong Kao, I-Chun Chen, and Chiun Hsu contributed equally to this work.

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Kao, HF., Chen, IC., Hsu, C. et al. Chlorhexidine for the prevention of bloodstream infection associated with totally implantable venous ports in patients with solid cancers. Support Care Cancer 22, 1189–1197 (2014). https://doi.org/10.1007/s00520-013-2071-5

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  • DOI: https://doi.org/10.1007/s00520-013-2071-5

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