Use of chlorhexidine for the prophylaxis of nosocomial infections in ICU

Clinical Microbiology and Antimicrobial Chemotherapy. 2020; 22(1):30-38

​ Bagin V.A., Rudnov V.A., Astafieva M.N.
10.36488/cmac.2020.1.30-38
chlorhexidine nosocomial infections intensive care unit ICU
Section
Antimicrobials
Type
Review
Publication
Clinical Microbiology and Antimicrobial Chemotherapy. 2020; 22(1):30-38

Abstract

This review summarizes published data on the use of chlorhexidine for the prevention of nosocomial infections in the intensive care units (ICU). The use of a 0.5–2.0% alcohol solution of chlorhexidine is strongly recommended for the surgical site decontamination before surgical intervention or vascular puncture for the prevention of surgical site infections and catheter-associated bloodstream infections. The following measures could be considered: daily skin decontamination with water solution of chlorhexidine (chlorhexidine bathing) in ICU for the prevention of catheter-associated bloodstream infection; the use of impregnated with chlorhexidine dressing for the prevention of catheter-associated bloodstream infections and catheter colonization; cleaning of the urinary meatus with water solution of chlorhexidine for the prevention of catheter-associated urinary tract infections. A routine use of chlorhexidine solution for oral care to prevent ventilator-associated pneumonia is not reasonable. The risks of contact dermatitis, anaphylaxis and emergence of chlorhexidine-resistant microorganisms should be considered when using chlorhexidine.

Vladimir A. Bagin

City Clinical Hospital #40, Yekaterinburg, Russia
Ural State Medical University, Yekaterinburg, Russia

Vladimir A. Rudnov

City Clinical Hospital #40, Yekaterinburg, Russia
Ural State Medical University, Yekaterinburg, Russia

Astafieva M.N.

City Clinical Hospital #40, Yekaterinburg, Russia
Ural State Medical University, Yekaterinburg, Russia

  • 1. Davies G.E., Francis J., Martin A.R., Rose F.L., Swain G. 1:6-Di4-chlorophenyldiguanidohexane ("Hibitane"). Laboratory investigation of a new antibacterial agent of high potency. Brit J Pharmacol Chemother. 1954;9(2):192-196. DOI: 10.1111/j.1476-5381.1954.tb00840.x
  • 2. Lim K-S., Kam P.C.A. Chlorhexidine – pharmacology and clinical applications. Anaesth Intensive Care. 2008;36(4):502-512. DOI: 10.1177/0310057x0803600404
  • 3. Johnson P.D., Martin R., Burrell L.J., Grabsch E.A., Kirsa S.W., O’Keeffe J., et al. Efficacy of an alcohol/chlorhexidine hand hygiene program in a hospital with high rates of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection. Med J Aust. 2005;183(10):509-514. DOI: 10.5694/j.13265377.2005.tb07151.x
  • 4. Kampf G., Kramer A., Suchomel M. Lack of sustained efficacy for alcohol-based surgical hand rubs containing “residual active ingredients” according to EN 12791. J Hosp Infect. 2017;95(2):163-168. DOI: 10.1016/j.jhin.2016.11.001
  • 5. Denton G.W. Chlorhexidine. In: Block S., ed. Disinfection, Sterilization, and Prevention. Philadelphia: Lippincott, Williams and Wilkins. 2000:321-336.
  • 6. Cowen J., Ellis S.H., McAinsh J. Absorption of chlorhexidine from the intact skin of newborn infants. Arch Dis Child. 1979;54(5):379-383. DOI: 10.1136/adc.54.5.379
  • 7. Ling M.L., Apisarnthanarak A., Madriaga G. The burden of healthcare-a infections in southeast Asia: A systematic literature review and meta-analysis. Clin Infect Dis. 2015;60(11):16901699. DOI: 10.1093/cid/civ095
  • 8. Yakovlev S.V., Suvorova M.P., Beloborodov V.B., Basin E.E., Eliseev E.V., Kovelenov S.V., et al. Multicentre study of the prevalence and clinical value of hospital-acquired infections in emergency hospitals of Russia: ERGINI study team. Antibiotiki i himioterapija. 2016;61(5-6):32-42. Russian.
  • 9. Dudeck M.A., Weiner L.M., Allen-Bridson K., Malpiedi P.J., Peterson K.D., Pollock D.A., et al. National Healthcare Safety Network (NHSN) report, data summary for 2012, Deviceassociated module. Am J Infect Control. 2013;41(12):11481166. DOI: 10.1016/j.ajic.2013.09.002
  • 10. Garrouste-Orgeas M., Chevret S., Arlet G., Marie O., Rouveau M., Popoff N., et al. Oropharyngeal or gastric colonization and nosocomial pneumonia in adult intensive care unit patients. Am J Respir Crit Care Med. 1997;156(5):16471655. DOI: 10.1164/ajrccm.156.5.96-04076
  • 11. Torres A., Niederman M.S., Chastre J., Ewig S., FernandezVandellos P., Hanberger H., et al. International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia. Eur Respir J. 2017;50(3):1700582. DOI: 10.1183/13993003.00582-2017
  • 12. Klompas M., Branson R., Eichenwald E.C., Greene L.R., Howell M.D., Lee G., et al. Strategies to prevent ventilatorassociated pneumonia in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35(8):915-936. DOI: 10.1086/677144
  • 13. DeRiso A.J., Ladowski J.S., Dillon T.A., Justice J.W., Peterson A.C. Chlorhexidine gluconate 0.12% oral rinse reduces the incidence of total nosocomial respiratory infection and nonprophylactic systemic antibiotic use in patients undergoing heart surgery. Chest. 1996;109(6):1556-1561. DOI: 10.1378/chest.109.6.1556
  • 14. Houston S., Hougland P., Anderson J.J., LaRocco M., Kennedy V., Gentry L.O. Effectiveness of 0.12% chlorhexidine gluconate oral rinse in reducing prevalence of nosocomial pneumonia in patients undergoing heart surgery. Am J Crit Care. 2002;11(6):567-570. DOI: 10.4037/ajcc2002.11.6.567
  • 15. Nicolosi L.N., del Carmen Rubio M., Martinez C.D., Gonzalez N.N., Cruz M.E. Effect of oral hygiene and 0.12% chlorhexidine gluconate oral rinse in preventing ventilatorassociated pneumonia after cardiovascular surgery. Respir Care. 2014;59(4):504-509. DOI: 10.4187/respcare.02666
  • 16. American Thoracic Society; Infectious Diseases Society of America. Guidelines for the management of adults with hospitalacquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171(4):388-416. DOI: 10.1164/rccm.200405-644st
  • 17. Masterton R.G., Galloway A., French G., Street M., Armstrong J., Brown E., et al. Guidelines for the management of hospital-acquired pneumonia in the UK: Report of the Working Party on HospitalAcquired Pneumonia of the British Society for Antimicrobial Chemotherapy. J Antimicrob Chemother. 2008;62(1):5-34. DOI: 10.1093/jac/dkn162
  • 18. Rello J., Lode H., Cornaglia G., Masterton R. VAP Care Bundle Contributors. A European care bundle for prevention of ventilatorassociated pneumonia. Intens Care Med. 2010;36(5):773-780. DOI: 10.1007/s00134-010-1841-5
  • 19. Klompas M., Speck K., Howell M.D., Greene L.R., Berenholtz S.M. Reappraisal of routine oral care with chlorhexidine gluconate for patients receiving mechanical ventilation. JAMA Intern Med. 2014;174(5):751. DOI: 10.1001/jamainternmed.2014.359
  • 20. Plantinga N.L., Wittekamp B.H.J., Leleu K., Depuydt P., Van den Abeele A-M., Brun-Buisson C., et al. Oral mucosal adverse events with chlorhexidine 2% mouthwash in ICU. Intens Care Med. 2016;42(4):620-621. DOI: 10.1007/s00134-016-4217-7
  • 21. Klompas M. Oropharyngeal Decontamination with Antiseptics to Prevent Ventilator-associated pneumonia: rethinking the benefits of chlorhexidine. Semin Respir Crit Care Med. 2017;38(03):381390. DOI: 10.1055/s-0037-1602584
  • 22. Xue Y., Zhang S., Yang Y., Lu M., Wang Y., Zhang T., et al. Acute pulmonary toxic effects of chlorhexidine (CHX) following an intratracheal instillation in rats. Hum Exp Toxicol. 2011;30(11): 1795-1803. DOI: 10.1177/0960327111400104
  • 23. Hirata K., Kurokawa A. Chlorhexidine gluconate ingestion resulting in fatal respiratory distress syndrome. Vet Hum Toxicol. 2002;44(2):89-91. PMID: 11931511
  • 24. Price R., MacLennan G., Glen J. Selective digestive or oropharyngeal decontamination and topical oropharyngeal chlorhexidine for prevention of death in general intensive care: systematic review and network meta-analysis. BMJ. 2014;348:g2197. DOI: 10.1136/bmj.g2197
  • 25. Deschepper M., Waegeman W., Eeckloo K., Vogelaers D., Blot S. Effects of chlorhexidine gluconate oral care on hospital mortality: a hospital-wide, observational cohort study. Intens Care Med. 2018;44(7):1017-1026. DOI: 10.1007/s00134-018-5171-3
  • 26. Gershengorn H.B., Garland A., Kramer A., Scales D.C., Rubenfeld G., Wunsch H. Variation of arterial and central venous catheter use in United States intensive care units. Anesthesiology. 2014;120(3):650-664. DOI: 10.1097/ALN.0000000000000008
  • 27. Huang V. Effect of a patency bundle on central venous catheter complications among hospitalized adult patients. JBI Database System Rev Implement Rep. 2018;16(2):565-586. DOI: 10.11124/jbisrir-2016-003340
  • 28. Salm F., Schwab F., Behnke M., Brunkhorst F.M., Scherag A., Geffers C., et al. Nudge to better care – blood cultures and catheter-related bloodstream infections in Germany at two points in time (2006, 2015). Antimicrob Resist Infect Control. 2018;7(1). DOI: 10.1186/s13756-018-0432-z
  • 29. Ling M.L., Apisarnthanarak A., Jaggi N., Harrington G., Morikane K., Thu le T.A., et al. APSIC guide for prevention of Central Line Associated Bloodstream Infections (CLABSI). Antimicrob Resist Infect Control. 2016;5(1). DOI: 10.1186/s13756-016-0116-5
  • 30. Kozlov R.S., Golub A.V. Catheter-related Bloodstream Infections: Prevention or Treatment? Klinicheskaja mikrobiologija i antimikrobnaja himioterapija. 2010;12(1):23-30. Russian.
  • 31. Mermel L.A. What Is The predominant source of intravascular catheter infections? Clin Infect Dis. 2010;52(2):211-212. DOI: 10.1093/cid/ciq108
  • 32. Rotter M. Hand washing and hand disinfection. In: Mayhall C.G., ed. Hospital Epidemiology and Infection Control, 3rd ed. Philadelphia: Lippincott Williams and Wilkins. 2012:1365-1383.
  • 33. O’Grady N.P., Alexander M., Burns L.A., Dellinger E.P., Garland J., Heard S.O., et al. Summary of recommendations: guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis. 2011;52(9):1087-1099. DOI: 10.1093/cid/cir138
  • 34. Marschall J., Mermel L.A., Fakih M., Hadaway L., Kallen A., O’Grady N.P., et al. Strategies to prevent central line-associated bloodstream infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35(S2):S89-S107. DOI: 10.1017/s0899823x00193870
  • 35. Loveday H.P., Wilson J.A., Pratt R.J., Golsorkhi M., Tingle A., Bak A., et al. epic3: National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect. 2014;86:S1-S70. DOI: 10.1016/s0195-6701(13)60012-2
  • 36. Bikkulova D.Sh., Zabolotskiy D.V., Ershova O.N., Kulabuhov V.V., Briko N.I. Prevention of catheter-associated bloodstream infections and care for a central venous catheter (CVC). Federal clinical guidelines. Moskva, 2014, 20 p. Available at: http://nasci.ru/?id=3377. Accessed Dec 23, 2019. Russian.
  • 37. Société française d’anesthésie et de réanimation (Sfar), Société de réanimation de langue française (SRLF). Prévention des infections nosocomiales en réanimation (transmission croisée et nouveau-né exclus). Annales Françaises d'Anesthésie et de Réanimation. 2009;28:912-920. DOI: 10.1016/j.annfar.2009.09.007
  • 38. Mimoz O., Lucet J-C., Kerforne T., Pascal J., Souweine B., Goudet V., et al. Skin antisepsis with chlorhexidine-alcohol versus povidone iodine–alcohol, with and without skin scrubbing, for prevention of intravascular-catheter-related infection (CLEAN): an open-label, multicentre, randomised, controlled, two-by-two factorial trial. Lancet. 2015;386(10008):2069-2077. DOI: 10.1016/s0140-6736(15)00244-5
  • 39. Rupp M.E., Yu S., Huerta T., Cavalieri R.J., Alter R., Fey P.D., et al. Adequate disinfection of a split-septum needleless intravascular connector with a 5-second alcohol scrub. Infect Control Hosp Epidemiol. 2012;33(7):661-665. DOI: 10.1086/666337
  • 40. Safdar N., O’Horo J.C., Ghufran A., Bearden A., Didier M.E., Chateau D., et al. Chlorhexidine-impregnated dressing for prevention of catheter-related bloodstream infection. Crit Care Med. 2014;42(7):1703-1713. DOI: 10.1097/ccm.0000000000000319
  • 41. Wei L., Li Y., Li X., Bian L., Wen Z., Li M. Chlorhexidine-impregnated dressing for the prophylaxis of central venous catheter-related complications: a systematic review and meta-analysis. BMC Infect Dis. 2019;19(1). DOI: 10.1186/s12879-019-4029-9
  • 42. Ullman A.J., Cooke M.L., Mitchell M., Lin F., New K., Long D.A., et al. Dressing and securement for central venous access devices (CVADs): A Cochrane systematic review. Int J Nurs Stud. 2016;59:177-196. DOI: 10.1016/j.ijnurstu.2016.04.003
  • 43. Petrosillo N., Drapeau C.M., Nicastri E., Martini L., Ippolito G., et al. Surgical site infections in Italian hospitals: a prospective multicenter study. BMC Infect Dis. 2008;8(1). DOI: 10.1186/1471-2334-8-34
  • 44. Mangram A.J., Horan T.C., Pearson M.L., Silver L.C., Jarvis W.R. Guideline for prevention of surgical site infection. Infect Control Hosp Epidemiol. 1999;20(4):247-280. DOI: 10.1086/501620
  • 45. Coello R., Charlett A., Wilson J., Ward V., Pearson A., Borriello P. Adverse impact of surgical site infections in English hospitals. J Hosp Infect. 2005;60(2):93-103. DOI: 10.1016/j.jhin.2004.10.019
  • 46. Kamel C., McGahan L., Polisena J., Mierzwinski-Urban M., Embil J.M. Preoperative skin antiseptic preparations for preventing surgical site infections: a systematic review. Infect Control Hosp Epidemiol. 2012;33(6):608-617. DOI: 10.1086/665723
  • 47. Lee I., Agarwal R.K., Lee B.Y., Fishman N.O., Umscheid C.A. Systematic review and cost analysis comparing use of chlorhexidine with use of iodine for preoperative skin antisepsis to prevent surgical site infection. Infect Control Hosp Epidemiol. 2010;31(12):1219-1229. DOI: 10.1086/657134
  • 48. Noorani A., Rabey N., Walsh S.R., Davies R.J. Systematic review and meta-analysis of preoperative antisepsis with chlorhexidine versus povidone-iodine in clean-contaminated surgery. Br J Surg. 2010;97(11):1614-1620. DOI: 10.1002/bjs.7214
  • 49. Privitera G.P., Costa A.L., Brusaferro S., Chirletti P., Crosasso P., Massimetti G., et al. Skin antisepsis with chlorhexidine versus iodine for the prevention of surgical site infection: A systematic review and meta-analysis. Am J Infect Control. 2017;45(2):180189. DOI: 10.1016/j.ajic.2016.09.017
  • 50. Surgical site infection: prevention and treatment. Evidence review for the effectiveness of closure materials and techniques in the prevention of surgical site infection. NICE guideline: NG125 evidence reviews. 2019. Available at: www.nice.org.uk/guidance/ng125. Accessed Dec 23, 2019.
  • 51. Global guidelines for the prevention of surgical site infection, second edition. World Health Organization 2018. Available at: https://apps.who.int/iris/bitstream/han dle/10665/277399/9789241550475-eng.pdf?ua=1. Accessed Dec 23, 2019.
  • 52. Nicolle L.E. Catheter associated urinary tract infections. Antimicrob Resist Infect Control. 2014;3(1). DOI: 10.1186/2047-2994-3-23
  • 53. Gardner A., Mitchell B., Beckingham W., Fasugba O. A point prevalence cross-sectional study of healthcareassociated urinary tract infections in six Australian hospitals. BMJ Open. 2014;4(7):e005099-e005099. DOI: 10.1136/bmjopen-2014-005099
  • 54. Magill S.S., Edwards J.R., Bamberg W., Beldavs Z.G., Dumyati G., Kainer M.A., et al. Multistate point-prevalence survey of health care-associated infections. N Engl J Med. 2014;370(13):11981208. DOI: 10.1056/nejmoa1306801
  • 55. Gastmeier P., Behnke M., Schwab F., Geffers C. Benchmarking of urinary tract infection rates: experiences from the intensive care unit component of the German national nosocomial infections surveillance system. J Hosp Infect. 2011;78(1):41-44. DOI: 10.1016/j.jhin.2011.01.021
  • 56. Mitchell B.G., Ferguson J.K., Anderson M., Sear J., Barnett A. Length of stay and mortality associated with healthcareassociated urinary tract infections: a multi-state model. J Hosp Infect. 2016;93(1):92-99. DOI: 10.1016/j.jhin.2016.01.012
  • 57. Hooton T.M., Bradley S.F., Cardenas D.D., Colgan R., Geerlings S.E., Rice J.C., et al. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 international clinical practice guidelines from the Infectious Diseases Society of America. Clin Infect Dis. 2010;50(5):625663. DOI: 10.1086/650482
  • 58. Fasugba O., Cheng A.C., Gregory V., Graves N., Koerner J., Collignon P., et al. Chlorhexidine for meatal cleaning in reducing catheter-associated urinary tract infections: a multicentre stepped-wedge randomised controlled trial. Lancet Infect Dis. 2019;19(6):611-619. DOI: 10.1016/s14733099(18)30736-9
  • 59. Lo E., Nicolle L.E, Coffin S.E., Gould C., Maragakis L.L., Meddings J., et al. Strategies to prevent catheter-associated urinary tract infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35(5):464-479. DOI: 10.1086/675718
  • 60. Karki S., Cheng A.C. Impact of non-rinse skin cleansing with chlorhexidine gluconate on prevention of healthcare-associated infections and colonization with multi-resistant organisms: a systematic review. J Hosp Infect. 2012;82(2):71-84. DOI: 10.1016/j.jhin.2012.07.005
  • 61. Climo M.W., Yokoe D.S., Warren D.K., Perl T.M., Bolon M., Herwaldt L.A., et al. Effect of daily chlorhexidine bathing on hospital-acquired infection. N Engl J Med. 2013;368(6):533542. DOI: 10.1056/nejmoa1113849
  • 62. Noto M.J., Domenico H.J., Byrne D.W., Talbot T., Rice T.W., Bernard G.R., et al. Chlorhexidine bathing and health careassociated infections. JAMA. 2015;313(4):369. DOI: 10.1001/jama.2014.18400
  • 63. Boonyasiri A., Thaisiam P., Permpikul C., Judaeng T., Suiwongsa B., Apiradeewajeset N., et al. Effectiveness of chlorhexidine wipes for the prevention of multidrug-resistant bacterial colonization and hospital-acquired infections in intensive care unit patients: a randomized trial in Thailand. Infect Control Hosp Epidemiol. 2015;37(3):245-253. DOI: 10.1017/ice.2015.285
  • 64. O’Horo J.C., Silva G.L.M., Munoz-Price L.S., Safdar N. The Efficacy of daily bathing with chlorhexidine for reducing healthcare-associated bloodstream infections: a meta-analysis. Infect Control Hosp Epidemiol. 2012;33(3):257-267. DOI: 10.1086/664496
  • 65. Shah H.N., Schwartz J.L., Luna G., Cullen D.L. Bathing with 2% chlorhexidine gluconate: evidence and costs associated with central line-associated bloodstream infections. Crit Care Nurs Q. 2016;39(1):42-50. DOI: 10.1097/cnq.0000000000000096
  • 66. Frost S.A., Hou Y.C., Lombardo L., Metcalfe L., Lynch J.M., Hunt L., et al. Evidence for the effectiveness of chlorhexidine bathing and health care-associated infections among adult intensive care patients: a trial sequential meta-analysis. BMC Infect Dis. 2018;18(1). DOI: 10.1186/s12879-018-3521-y
  • 67. Choi E.Y., Park D-A., Kim H.J., Park J. Efficacy of chlorhexidine bathing for reducing healthcare associated bloodstream infections: a meta-analysis. Ann Intensive Care. 2015;5(1). DOI: 10.1186/s13613-015-0073-9
  • 68. Webster J., Osborne S. Preoperative bathing or showering with skin antiseptics to prevent surgical site infection. Cochrane Database Syst Rev. 2007(2):CD004985. DOI: 10.1002/14651858.CD004985.pub4
  • 69. Burdon D.W., Whitby J.L. Contamination of hospital disinfectants with Pseudomonas species. BMJ. 1967;2(5545):153-155. DOI: 10.1136/bmj.2.5545.153
  • 70. Speller D.C., Stephens M.E., Viant A.C. Hospital infection by Pseudomonas cepacia. Lancet. 1971;297(7703):798-799. DOI: 10.1016/s0140-6736(71)91236-0
  • 71. Coyle-Gilchrist M.M., Crewe P., Roberts G. Flavobacterium meningosepticum in the hospital environment. J Clin Pathol. 1976;29(9):824-826. DOI: 10.1136/jcp.29.9.824
  • 72. Marrie T.J., Costerton J.W. Prolonged survival of Serratia marcescens in chlorhexidine. Appl Environ Microbiol. 1981;42:1093-1102. PMID: 7032422
  • 73. Wishart M.M., Riley T.V. Infection with Pseudomonas maltophilia hospital outbreak due to contaminated disinfectant. Med J Aust. 1976;2(19):710-712. PMID: 1004317
  • 74. Vigeant P., Loo V.G., Bertrand C., Dixon C., Hollis R., Pfaller M.A., et al. An outbreak of Serratia marcescens infections related to contaminated chlorhexidine. Infect Control Hosp Epidemiol. 1998;19(10):791-794. DOI: 10.1086/647728
  • 75. Sauer K., Rickard A.H., Davies D.G. Biofilms and Biocomplexity. Microbe. 2007;2(7):347-353. DOI: 10.1128/microbe.2.347.1
  • 76. Detusheva E.V., Rodin V.B., Slukin P.V., Ershova O.N., Aleksandrova I.A., Kurdyumova N.V., et. al. Susceptibility of nosocomial K. pneumoniae, P. aeruginosa, A. baumannii, and P. mirabilis strains to a chlorhexidine-based antiseptic preparation. Klinicheskaja mikrobiologija i antimikrobnaja himioterapija. 2015;17(1):57-66. Russian.
  • 77. Tattawasart U., Maillard J-Y., Furr J., Russell A. Outer membrane changes in Pseudomonas stutzeri resistant to chlorhexidine diacetate and cetylpyridinium chloride. Int J Antimicrob Agents. 2000;16(3):233-238. DOI: 10.1016/s0924-8579(00)00206-5
  • 78. Thomas L., Maillard J.Y., Lambert R.J., Russell A.D. Development of resistance to chlorhexidine diacetate in Pseudomonas aeruginosa and the effect of a residual concentration. J Hosp Infect. 2000;46:297-303. DOI: 10.1053/jhin.2000.0851
  • 79. Wand M.E., Bock L.J., Bonney L.C., Sutton J.M. Mechanisms of increased resistance to chlorhexidine and cross-resistance to colistin following exposure of Klebsiella pneumoniae clinical isolates to chlorhexidine. Antimicrob Agents Chemother. 2016;61(1):e01162-16. DOI: 10.1128/AAC.01162-16
  • 80. Tanaka T., Murayama S., Tuda N., Nishiyama M., Nakagawa K., Matsuo Y., et al. Microbial Degradation of Disinfectants. A new chlorhexidine degradation intermediate (CHDI), CHDI-C, produced by Pseudomonas sp. strain No. A-3. J Health Sci. 2005;51(3):357-361. DOI: 10.1248/jhs.51.357
  • 81. Odedra K.M., Farooque S. Chlorhexidine: an unrecognized cause of anaphylaxis. Postgrad Med J. 2014;90(1070):709-714. DOI: 10.1136/postgradmedj-2013-132291
  • 82. Antunes J., Kochuyt A-M., Ceuppens J.L. Perioperative allergic reactions: Experience in a Flemish referral centre. Allergol Immunopathol (Madr). 2014;42(4):348-354. DOI: 10.1016/j.aller.2013.08.001
  • 83. US Food and Drug Administration. FDA Drug Safety Communication: FDA warns about rare but serious allergic reactions with the skin antiseptic chlorhexidine gluconate. 2 Feb 2017. Available at: www.fda.gov/Drugs/DrugSafety/ucm530975.htm. Accessed Dec 23, 2019.
  • 84. Nakonechna A., Dore P., Dixon T., Khan S., Deacock S., Holding S., et al. Immediate hypersensitivity to chlorhexidine is increasingly recognised in the United Kingdom. Allergol Immunopathol (Madr). 2014;42(1):44-49. DOI: 10.1016/j.aller.2012.08.001
  • 85. Garvey L.H., Krøigaard M., Poulsen L.K., Skov P.S., Mosbech H., Venemalm L., et al. IgE-mediated allergy to chlorhexidine. J Allergy Clin Immunol. 2007;120(2):409-415. DOI: 10.1016/j.jaci.2007.04.029
  • 86. Toholka R., Nixon R. Allergic contact dermatitis to chlorhexidine. Australas J Dermatol. 2013;54(4):303-306. DOI: 10.1111/ajd.12087
  • 87. Wittczak T., Dudek W., Walusiak-Skorupa J., SwierczynskaMachura D., Palczynski C. Chlorhexidine-still an underestimated allergic hazard for health care professionals. Occup Med (Lond). 2013;63(4):301-305. DOI: 10.1093/occmed/kqt035
Views
0 Abstract
0 PDF
0 Crossref citations
Shared