Chlorhexidine-Alcohol versus Povidone-Iodine for Surgical-Site Antisepsis

被引:918
作者
Darouiche, Rabih O. [1 ,2 ]
Wall, Matthew J., Jr. [3 ]
Itani, Kamal M. F. [4 ,5 ]
Otterson, Mary F. [6 ,7 ]
Webb, Alexandra L. [8 ]
Carrick, Matthew M. [3 ]
Miller, Harold J. [3 ]
Awad, Samir S. [2 ]
Crosby, Cynthia T. [9 ]
Mosier, Michael C. [10 ]
AlSharif, Atef [2 ]
Berger, David H. [2 ]
机构
[1] Baylor Coll Med, Ctr Prostheses Infect, Houston, TX 77030 USA
[2] Michael E DeBakey Vet Affairs Med Ctr, Houston, TX USA
[3] Ben Taub Gen Hosp, Houston, TX 77030 USA
[4] Vet Affairs Boston Healthcare Syst, Boston, MA USA
[5] Boston Univ, Sch Med, Boston, MA 02118 USA
[6] Vet Affairs Med Ctr, Milwaukee, WI USA
[7] Med Coll Wisconsin, Milwaukee, WI 53226 USA
[8] Vet Affairs Med Ctr, Atlanta, GA 30033 USA
[9] Cardinal Hlth, Leawood, KS USA
[10] Washburn Univ, Topeka, KS 66621 USA
关键词
ELECTIVE COLORECTAL SURGERY; SUPPLEMENTAL PERIOPERATIVE OXYGEN; WOUND-INFECTION; ANTIMICROBIAL PROPHYLAXIS; PREVENTION; TRIAL; CEFOTETAN; HOSPITALIZATION; ANTIBIOTICS; MULTICENTER;
D O I
10.1056/NEJMoa0810988
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND Since the patient's skin is a major source of pathogens that cause surgical-site infection, optimization of preoperative skin antisepsis may decrease postoperative infections. We hypothesized that preoperative skin cleansing with chlorhexidine-alcohol is more protective against infection than is povidone-iodine. METHODS We randomly assigned adults undergoing clean-contaminated surgery in six hospitals to preoperative skin preparation with either chlorhexidine-alcohol scrub or povidone-iodine scrub and paint. The primary outcome was any surgical-site infection within 30 days after surgery. Secondary outcomes included individual types of surgical-site infections. RESULTS A total of 849 subjects (409 in the chlorhexidine-alcohol group and 440 in the povidone-iodine group) qualified for the intention-to-treat analysis. The overall rate of surgical-site infection was significantly lower in the chlorhexidine-alcohol group than in the povidone-iodine group (9.5% vs. 16.1%; P = 0.004; relative risk, 0.59; 95% confidence interval, 0.41 to 0.85). Chlorhexidine-alcohol was significantly more protective than povidone-iodine against both superficial incisional infections (4.2% vs. 8.6%, P = 0.008) and deep incisional infections (1% vs. 3%, P = 0.05) but not against organ-space infections (4.4% vs. 4.5%). Similar results were observed in the per-protocol analysis of the 813 patients who remained in the study during the 30-day follow-up period. Adverse events were similar in the two study groups. CONCLUSIONS Preoperative cleansing of the patient's skin with chlorhexidine-alcohol is superior to cleansing with povidone-iodine for preventing surgical-site infection after clean-contaminated surgery. (ClinicalTrials.gov number, NCT00290290.)
引用
收藏
页码:18 / 26
页数:9
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