05 July 2016
It is not only multi-resistant Staphylococcus aureus (MRSA) that now plays a dramatically increased role as an infectious agent in intensive care units (ICU). Other bacteria that are multi-resistant to a large number of major antibiotics, so-called MDRO (for example, VRE, ESBL, Clostridium difficile) are appearing more frequently as infectious agents not just in Germany (Geffers and Gastmeier 2011; Maechler et al. 2014). All these bacteria are responsible for an increasing number of cases of disease and death in ICUs.
Many hospitals are now taking preventative measures since treatment, if it is actually successful, it is expensive and time-consuming. These measures are designed to eliminate resistant bacteria before they can cause infection, particularly in intensive care units where patients are exposed to a high risk. Nasal vestibule, skin and other parts of the body where resistant bacteria linger are treated using decontaminating procedures and preparations. The aim is to reduce the amount of bacteria such that they can no longer be transmitted to other patients or trigger further infection (for example, infections in the bloodstream or wounds) (Evans et al. 2010).
Patients are often only washed using decontaminating preparations if the presence of resistant bacteria has been proven through a swab test in advance. However, some hospitals have recently moved towards this course of action for all patients in intensive care units regardless of bacterial status. The efficacy and costeffectiveness of such preventative washing has proved impressive in recent years in major clinical trials involving chlorhexidine (Climo et al. 2013; Huang et al. 2013; Huang et al. 2014).
While chlorhexidine plays a significant role internationally, octenidine-based preparations have gained recognition in Germany. Various studies involving preparations containing octenidine in patients colonised with MRSA have already returned excellent results when used for decontamination purposes (Krishna and Gibb 2010; Tanner et al. 2012; Spencer et al. 2013). Based on its properties (Hübner et al. 2010, Koburger et al. 2010), octenidine is regarded as being on a par with chlorhexidine for this use (Siegmund-Schultze 2013).
The Charité hospital in Berlin has now conducted a large-scale study in 17 intensive care units over 25 months on the efficacy of universal decontamination in the case of almost 30,000 intensive care patients. octenisan® wash mitts and octenisan® nasal gel were used. The number of bloodstream infections was reduced by 22% in the medical ICUs (8) and at the same time 42% fewer MRSA cases were recorded. However, similar results could not be confirmed in the surgical ICUs (9). The reasons for this were diverse. Surgical interventions meant that many BSIs could not be prevented through external decontamination. The time spent by the patients in surgical intensive care units was also shorter. This is known to have a
negative impact on decontamination success (Climo et al. 2013). A further positive outcome of the preventative washing was the saving of a total of 2,945 days of isolation, which in turn, represented a considerable cost saving.
The importance of using alternatives such as octenidine, for example, is emphasised by the fact that there is often resistance to significant anti-bacterial substances such as mupirocin and chlorhexidine (Poovelikunnel et al. 2015). These substances are currently used internationally mainly for decontaminating germ carriers. However, no resistance is known to date in the case of octenidine. Consequently, the evidence-based results that have now been published mean that a valuable alternative is available for decontaminating MDRO carriers. Controlled studies still need to confirm these results.
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Evans HL, Dellit TH, Chan J, Nathens AB, Maier RV, Cuschieri J. Effect of Chlorhexidine Whole-Body Bathing on Hospital-Acquired Infections Among Trauma Patients. Arch Surg. 2010;145(3):240-246. doi:10.1001/archsurg.2010.5.
Gastmeier P, Kämpf KP, Behnke M et al. An observational study of the universal use of octenidine to decrease nosocomial bloodstream infections and MDR organisms. J. Antimicrob. Chemother. 2016. doi:10.1093/jac/dkw170. First published May 27, 2016
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Poovelikunnel T., Gethin G., Humphreys H.: Mupirocin resistance: clinical implications and potential alternatives for the eradication of MRSA J. Antimicrob. Chemother. 2015; 70(10): 2681-2692 first published online July 3, 2015 doi:10.1093/jac/dkv169
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