Multicenter, multinational, prospective cohort study of the impact of chlorhexidine impregnated versus plain central lines on central line-associated bloodstream infections

Rosenthal VD 1 , Yin R 2 , Jin Z 2 , Basri MNM 3 , Hoong LY 3 , Mohamad F 3 Show all authors , El-Kholy A 4 , Bayani V 4 , Hatem R 4 , Myatra SN 5 , Páez LC 6 , Kharbanda M 7 , Nag B 7 , Guclu E 8 , Gazioglu EO 8 , Gupta S 9 , Tumu N 10

Affiliations 

  • 1 Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA; INICC Foundation, International Nosocomial Infection Control Consortium, Miami, FL, USA. Electronic address: vdr21@miami.edu
  • 2 Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
  • 3 International Islamic University Malaysia Department of Anesthesia and Critical Care, Kuantan, Malaysia
  • 4 Cairo University Dar Alfouad Hospital, 6th of October City, Egypt
  • 5 Tata Memorial Hospital Homi Bhabha National Institute, Mumbai, India
  • 6 Department of Infection Control, Clinica Iberoamerica de Clinicas Colsanitas, Barranquilla, Colombia
  • 7 Department of Critical Care, Desun Hospital, Kolkata, India
  • 8 Department of Microbiology, Sakarya University Training and Research Hospital, Sakarya, Turkey
  • 9 Department of Microbiology, Santokba Durlabhji Memorial Hospital, Jaipur, India
  • 10 Department of Infection Control, Port Moresby General Hospital, Port Moresby, Papua New Guinea
Am J Infect Control, 2025 Mar 06.
PMID: 40056993 DOI: 10.1016/j.ajic.2025.03.002

Abstract

BACKGROUND: We compared the efficacy of chlorhexidine-impregnated central lines (CLs) with plain CLs in preventing central line-associated bloodstream infections (CLABSIs) in critically ill patients.

METHODS: The study was conducted from April 2023 to August 2024 in 8 hospitals across India, Malaysia, Papua New Guinea, Colombia, Egypt, and Turkey. Data were collected prospectively using the INICC Surveillance Online System. Cases and controls were recruited simultaneously. Data were analyzed using t tests, χ² tests, and Fisher exact tests when indicated. Relative risks (RR) and their corresponding 95% confidence intervals (CI) were calculated.

RESULTS: A total of 6,672 patients were included. Patients with impregnated CLs had 4,721 CL-days, while those with plain CLs had 18,822 CL-days. The CLABSI rate in patients with impregnated CLs was 1.48 per 1,000 CL-days, compared to 4.78 per 1,000 CL-days in those with plain CLs (RR=0.31, 95%CI=0.14-0.67, P=.003). A subgroup analysis excluding patients with hemodialysis but using central venous catheters (CVCs) showed 1.72 CLABSIs per 1,000 CL-days in patients with impregnated CVCs compared to 5.84 per 1,000 CL-days in those with plain CVCs (RR=0.29, 95%CI=0.12-0.68, P=.004).

CONCLUSIONS: This study highlights the significant benefits of impregnated CLs over plain CLs in reducing CLABSI rates, achieving a 69% decrease in incidence.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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