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Insights into bacterial colonization of intensive care patients’ skin: the effect of chlorhexidine daily bathing

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Abstract

Skin is a major reservoir of bacterial pathogens in intensive care unit (ICU) patients. The aim of this study was to assess the skin bacterial richness and diversity in ICU patients and the effect of CHG daily bathing on skin microbiota. Twenty ICU patients were included during an interventional period with CHG daily bathing (n = 10) and a control period (n = 10). At day seven of hospitalization, eight skin swab samples (nares, axillary vaults, inguinal creases, manubrium and back) were taken from each patient. The bacterial identification was performed by microbial culturomics. We used the Shannon index to compare the diversity. We obtained 5,000 colonies that yielded 61 bacterial species (9.15 ± 3.7 per patient), including 15 (24.5 %) that had never been cultured from non-pathological human skin before, and three (4.9 %) that had never been cultured from human samples before. Notably, Gram-negative bacteria were isolated from all sites. In the water-and-soap group, there was a higher risk of colonization with Gram-negative bacteria (OR = 6.05, 95 % CI [1.67–21.90]; P = 0.006). In the CHG group, we observed more patients colonized by sporulating bacteria (9/10 vs. 3/10; P = 0.019) with a reduced skin bacterial richness (P = 0.004) and lower diversity (0.37, 95 % CI [0.33; 0.42] vs. 0.50, 95 % CI [0.48; 0.52]). Gram-negative bacteria are frequent and disseminated components of the transient skin flora in ICU patients. CHG daily bathing is associated with a reduction in Gram-negative bacteria colonization together with substantial skin microbiota shifts.

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Acknowledgments

We acknowledge Georgette Grech and Isabelle Jousset for their technical assistance, and Anderson Loundou for reviewing the statistical methods. Sage products provided the single-use, no-rinse disposable cloths saturated with 2 % chlorhexidine gluconate.

Competing interests

The authors declare that they have no competing interests.

Authors’ contribution

LP, BLS, and DR conceived of the study and participated in its design. NC carried out the experiments, and drafted the manuscript. LP took care of the patients. NC, LP, PEF, DR and BLS analysed the data. LP, PEF, DR, and BLS helped to draft the manuscript. All the authors revised and approved the manuscript.

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Authors and Affiliations

  1. Unité de Recherche sur les Maladies Infectieuses Tropicales et Emergentes, URMITE, UM63, CNRS 7278, IRD 198, INSERM 1095, Méditerranée-Infection, Aix-Marseille-Université, Marseille, France

    N. Cassir, L. Papazian, P.-E. Fournier, D. Raoult & B. La Scola

  2. Service de Réanimation des Détresses Respiratoires et Infections Sévères, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Marseille, France

    L. Papazian

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  1. N. Cassir
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Correspondence to B. La Scola.

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Cassir, N., Papazian, L., Fournier, PE. et al. Insights into bacterial colonization of intensive care patients’ skin: the effect of chlorhexidine daily bathing. Eur J Clin Microbiol Infect Dis 34, 999–1004 (2015). https://doi.org/10.1007/s10096-015-2316-y

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  • DOI: https://doi.org/10.1007/s10096-015-2316-y

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