Healthcare-associated infections (HAIs) caused by multi-drug-resistant Gram-negative bacteria (MDRGNB) have increased prevalence in intensive care units (ICUs). A common strategy to prevent HAIs is bathing patients with chlorhexidine gluconate (CHG). However, the effectiveness of CHG bathing against multidrug-resistant Acinetobacter baumannii (MDRAB) is still controversial. The aim of this study was to perform a systematic review and meta-analysis of the effectiveness of CHG bathing on Acinetobacter baumannii colonization and infection in the ICU setting. A systematic literature search of PubMed, EMBASE, Web of Science and CINAHL was performed from inception through to June 2018. Randomized controlled trials (RCTs), pre-post studies, or interrupted time series (ITS) studies were included. The numbers of patients with/without colonization or infection of A. baumannii in the experimental or control groups were extracted from each study. Quality assessment was performed by the related instruments of National Institute of Health. Pooled risk ratios (RRs) were calculated using the random-effects model. One RCT and 12 pre-post or ITS studies comprising 18,217 patients were included, of which 8069 were in the CHG bathing arm and 9051 in the control arm. CHG bathing was associated with a reduced colonization of A. baumannii (RR, 0.66; 95% confidence interval: 0.57-0.77; P<0.001). Chlorhexidine at 4% showed a better effect than 2% chlorhexidine (meta-regression P=0.044). CHG bathing was associated with a non-significant reduction of infection (pooled RR 0.41, 95% CI: 0.13-1.25). This study suggests that CHG bathing significantly reduces colonization of A. baumannii in the ICU setting. However, more trials are needed to confirm whether CHG bathing can reduce infections with A. baumannii.

中文翻译：

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洗必泰对鲍曼不动杆菌定植或感染的影响：系统评价和荟萃分析。

由多重耐药性革兰氏阴性菌（MDRGNB）引起的医疗保健相关感染（HAIs）在重症监护病房（ICU）中的患病率增加。预防HAI的常见策略是为患者洗净葡萄糖酸氯己定（CHG）。但是，CHG沐浴对多重耐药鲍曼不动杆菌（MDRAB）的有效性仍存在争议。这项研究的目的是对重症监护病房中CHG沐浴对鲍曼不动杆菌的定殖和感染的有效性进行系统的回顾和荟萃分析。从开始到2018年6月，对PubMed，EMBASE，Web of Science和CINAHL进行了系统的文献检索。包括随机对照试验（RCT），事前研究或中断时间序列（ITS）研究。从每个研究中提取实验组或对照组中有/没有鲍曼不动杆菌定植或感染的患者数量。通过国立卫生研究院的相关仪器进行质量评估。使用随机效应模型计算汇总风险比（RRs）。包括一项RCT和12项包括18,217例患者的事前或ITS研究，其中8069例在CHG沐浴组中，而9051例在对照组中。CHG沐浴与鲍曼不动杆菌的定殖减少有关（RR，0.66； 95％置信区间：0.57-0.77； P <0.001）。4％的氯己定比2％的氯己定显示更好的效果（Meta回归P = 0.044）。CHG沐浴与感染无明显减少相关（合并RR 0.41，95％CI：0.13-1.25）。这项研究表明，在加护病房中，CHG沐浴显着减少了鲍曼不动杆菌的定殖。但是，需要更多的试验来确认CHG沐浴是否可以减少鲍曼不动杆菌的感染。