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PubMed2025

Universal versus targeted chlorhexidine and mupirocin decolonisation and clinical and molecular epidemiology of Staphylococcus epidermidis bloodstream infections in patients in intensive care in Scotland, UK: a controlled time-series and longitudinal genotypic study.

BACKGROUND: There are concerns that biocide skin and mucous membrane decolonisation, which is widely used to prevent health-care-associated infections in intensive care units (ICUs), might select for multidrug-resistant pathogens. We aimed to evaluate the effects of de-escalating from universal to targeted skin and nasal decolonisation on Staphylococcus epidermidis bloodstream infections (SE-BSI). METHODS: We did a retrospective, before-after-control-impact time-series analysis and longitudinal genotypic study in two ICUs with divergent decolonisation practice in tertiary care hospitals of adjacent health boards in Scotland, UK. Participants were aged at least 16 years and admitted between July 1, 2009, and Feb 28, 2022. There were no exclusion criteria for the study. In ICU one (intervention site) universal decolonisation in all admissions was de-escalated to targeted decolonisation of meticillin-resistant Staphylococcus aureus (MRSA) carriers on Feb 1, 2019, while in ICU two (control site) targeted decolonisation was applied throughout. We collected bloodstream infection data from all causes, including clinically significant SE-BSI. Antimicrobial susceptibility testing was used to define meticillin-resistant S epidermidis (MRSE) and chlorhexidine susceptibility. We used multilocus sequence typing to identify sequence types from archived SE-BSI isolates. Whole-genome sequencing was applied to a sample from ICU one. The primary outcomes were incidence densities of all bloodstream infections, SE-BSI, and meticillin-resistant S epidermidis bloodstream infections (MRSE-BSI), and the percentage probability that SE-BSI were MRSE-BSI. The effects of de-escalation on primary outcomes were estimated by differences between the intervention and control sites, before and after de-escalation, using a before-after-control-impact time-series design. Secondary outcomes included the proportion of multidrug resistant sequence types, carriage of mobile genetic elements and genes for multidrug resistance and biofilm production. FINDINGS: Between July 1, 2009, and Feb 28, 2022, S epidermidis was identified in 334 (45%) of 735 bloodstream infections in ICU one, of which 197 occurred before the de-escalation intervention in Feb 1, 2019, and S epidermidis was identified in 167 (60%) of 278 bloodstream infections in ICU two. There was no increase in all bloodstream infection incidence coinciding with de-escalation in ICU one, whereas MRSE-BSI incidence declined significantly from 10·4 cases per 1000 occupied bed days (OBDs; 95% credible interval [CrI] 7·2-15·4) to 4·3 cases per 1000 OBDs (2·5-6·7), as did the percentage probability of MRSE (from 89·2%, 95% CrI 77·8-96·5 to 56·7%, 34·3-77·5%). No significant changes in the primary outcomes were seen in ICU two. MRSE-BSI incidence density was positively associated with chlorhexidine use, but not mupirocin use. De-escalation was associated with a reduced proportion of SE-BSI due to multidrug-resistant sequence types and reduced carriage of mobile genetic elements and genes for multidrug resistance and biofilm production, as observed by multi-locus sequence typing and whole genome sequencing. INTERPRETATION: In ICU settings with low MRSA incidence, the benefits of universal decolonisation should be balanced against the risks of selecting MRSE sequence types adapted for invasive and device-associated infection. FUNDING: National Health Service Grampian Charity.

Humans↗
PubMed2005

The effect of the use of 2% chlorhexidine gel in post-space preparation on carbon fiber post retention.

OBJECTIVE: Evaluate the bond strength of a resin cement used to lute carbon fiber posts, when drills and 4 different substances were used for the post-space preparation. STUDY DESIGN: Forty human canines were treated endodontically, and had a 10-mm length post space preparation. Four different substances were used with the drills: G1 -saline, G2 -2% chlorhexidine gel, G3 -EDTA/NaOCl, and G4 -xylene. Carbon fiber posts (C-Post) were cemented with Allbond2 and Hi-X. Then, the posts were dislodged by tensional forces. RESULTS: The groups of chlrohexidine (G2) and xylene (G4) obtained superior average values of bond strength at the 5% significance level (Parametric analyzes ANOVA/Tukey/Scheffe) differing statistically from the other groups. There was no statistical significant difference between groups 2 and 4. CONCLUSION: Xylene and chlorhexidine gel are good substances for the post-space preparation but the second has the advantage of antimicrobial activity and low toxicity.

Analysis of Variance↗
PubMed2005

Effect of rotary or manual instrumentation, with or without a calcium hydroxide/1% chlorhexidine intracanal dressing, on the healing of experimentally induced chronic periapical lesions.

OBJECTIVE: To evaluate the healing of experimentally induced chronic periapical lesions in dogs at 30, 75, and 120 days after root canal instrumentation with rotary NiTi files or manual K-files, with or without a calcium hydroxide/1% chlorhexidine paste intracanal dressing. STUDY DESIGN: The second, third, and fourth mandibular premolars and the second and third maxillary premolars of 5 dogs (12 to 18 months of age, weighing 8 to 15 kg) were selected for treatment (a total of 82 root canals). After pulp removal, the root canals were left exposed to the oral cavity for 7 days to allow microbial contamination, after which the root canals were sealed with ZOE cement until periapical lesions were confirmed with radiography. Group I and II teeth were instrumented with manual K-files using the crown-down technique. In group III and IV teeth, NiTi rotary files were used. The apical delta was perforated by using #20 to #30 K-files at the length of the tooth, thus creating a standardized apical opening. The apical stop was enlarged to size 70, with 2.5% sodium hypochlorite irrigation at each file change. Teeth in groups II and IV were dressed with calcium hydroxide (Ca(OH) 2 )/1% chlorhexidine (CHX) paste for 15 days before root filling. Group I and III teeth did not receive an intracanal dressing. The access openings of the teeth were permanently restored with silver amalgam condensed on a glass ionomer cement base. Pairs of standardized periapical radiographs were taken at the beginning of the treatment (0 days) and at 30, 75, and 120 days after filling. RESULTS: There was no significant difference in the rate of radiographic healing of the periapical lesions between manual and rotary instrumentation. Radiographs taken at 120 days showed that the treatment with Ca(OH) 2 /1% CHX paste resulted in a significant reduction in mean size of the periapical lesions in comparison to single-session treatment. These findings were also true for histologic observations. CONCLUSION: The findings support the hypothesis that, regardless of the instrumentation technique (manual or rotary), the use of an intracanal dressing is important in the endodontic treatment of dog's teeth with experimentally induced chronic periapical lesions.

Analysis of Variance↗
PubMed1998

Efficacy of an alcohol-free chlorhexidine mouthrinse as an antimicrobial agent.

STATEMENT OF PROBLEM: Antimicrobial mouthrinses have become an important part of comprehensive dental care. However, mouthrinses that contain alcohol have been shown to be detrimental to patients undergoing radiation therapy for head and neck cancer, to some immunocompromised patients, to families with small children, and to persons sensitive to alcohol. PURPOSE: This study evaluated the effectiveness of alcohol-free, 0.12% chlorhexidine mouthrinse in reducing microbial levels when compared with commercially available 0.12% chlorhexidine (CHX) and essential oils mouthrinses. MATERIAL AND METHODS: This study consisted of both in vitro and in vivo investigations. The double-blind study included 32 subjects randomly assigned to 3 groups, equalized according to the indices tested. One group (n = 11) received essential oils rinse; the second group (n = 11) received CHX; and the last group (n = 10) received the alcohol-free CHX. Subjects were asked not to use any mechanical means of oral hygiene for 21 days. The in vitro part of the study consisted of Streptococcus mutans strip tests. RESULTS: Mean plaque scores for both CHX products decreased after 21 days, whereas the mean for the essential oils increased. Bleeding and gingival index scores for all 3 groups increased, which may be due to the initially healthy tissues of the participants. Relative microbial growth for S mutans for both the CHX products decreased to 0 after 21 days, whereas the counts for the essential oils group remained varied.

Adult↗
PubMed1997

Intracanal medicaments: evaluation of the antibacterial effects of chlorhexidine, metronidazole, and calcium hydroxide associated with three vehicles.

The use of an intracanal medicament may be helpful in eliminating remaining bacteria that survived inside root canals after complete chemomechanical preparation. This study evaluated the antibacterial activities of medicaments that act by means of contact, and not by vapor release, against obligate and facultative anaerobic bacteria commonly found in endodontic infections. The medicaments used were 0.12% chlorhexidine gel; 10% metronidazole gel; calcium hydroxide plus distilled water, calcium hydroxide plus camphorated paramonochlorophenol (CPMC); and calcium hydroxide plus glycerin. An agar diffusion test was used, and the zones of bacterial inhibition around each medicament were recorded and compared. The results revealed that calcium hydroxide/CPMC paste was effective against all bacterial strains tested. Chlorhexidine was also inhibitory to all strains. It was about as effective as calcium hydroxide/CPMC paste against most of the strains. Metronidazole also caused inhibition of growth of all obligate anaerobes tested and was more effective than calcium hydroxide/CPMC against two strains. Calcium hydroxide mixed with distilled water or glycerin failed to show zones of bacterial inhibition, probably because of limitations of the agar diffusion test.

Anti-Infective Agents, Local↗
PubMed1999

Severe anaphylaxis after a chlorhexidine bath.

Anaphylaxis to chlorhexidine is rare. We report a patient who experienced anaphylaxis during a whole body bath with chlorhexidine. Early signs of a type I allergy may have been masked because of previous concomitant treatment with corticosteroids and PUVA.

Administration, Cutaneous↗
PubMed1992

The efficacy of mupirocin ointment and chlorhexidine body scrubs in the eradication of nasal carriage of Staphylococcus aureus among patients undergoing long-term hemodialysis.

BACKGROUND: Patients undergoing long-term hemodialysis have a high prevalence of Staphylococcus aureus nasal carriage, which may lead to serious infections. Mupirocin ointment has been used intranasally to eradicate S. aureus carriage in health human volunteers and health care workers. Chlorhexidine, an antiseptic with excellent antistaphylococcal activity, is widely used for handwashing and skin cleansing. METHODS: Anterior nares cultures were obtained from patients older than 18 years who were undergoing long-term hemodialysis. Patients with S. aureus nasal carriage were enrolled in the study. Axillae and groins were cultured. Patients were given mupirocin ointment intranasally twice per day for 7 days and chlorhexidine body scrubs daily for the first 3 days. Follow-up cultures were obtained from anterior nares, axillae, and groins at 1 day, and 1, 4, 8 and 12 weeks after treatment. RESULTS: One day after completion of treatment nasal carriage was eradicated in 83% of patients (15/18). After 12 weeks, 69% of patients (11/16) were free of nasal carriage. CONCLUSIONS: Success rates of eradication were excellent compared with those in other published reports. This simple and effective regimen had no major side effects.

Administration, Intranasal↗
PubMed1984

Improved method for the determination of chlorhexidine in urine.

A high-performance liquid chromatographic method is described which is suitable for the determination of the common antiseptic chlorhexidine in urine. The method employs Sep-Pak cartridges to remove chlorhexidine from the urine matrix. Chromatographic separation was achieved on a C18 reversed-phase column using a mobile phase of methanol-20 mM sodium acetate solution (60:40) adjusted to pH 5 with glacial acetic acid. An ion-pair agent (pentadecafluorooctanoic acid) was used at a concentration of 100 micrograms ml-1 X 3-Bromobenzophenone was used as chromatographic standard (kappa' = 4.0). 4-Bromobenzophenone (kappa' = 3.9) or dibenzal hydrazine (kappa' = 4.4) may also be used. A series of urine samples was analysed and no interferences were observed. The method is simple and rapid with a total analysis time of ca. 30 min.

Chemical Phenomena↗
PubMedDate not supplied

Inadvertent use of chlorhexidine instead of balanced salt solution for intraocular irrigation.

In three consecutive cataract operations, chlorhexidine was inadvertently used as an intraocular irrigating solution as a result of inattentiveness of an assistant. In two of the three patients, corneal endothelium damage was so severe that penetrating keratoplasty had to be performed. Further effects included pronounced iris atrophy, anterior chamber applanation, and a retrocorneal membrane. In one case, an increase in intraocular pressure developed. No effects were observed in the retina or optic nerve. Inadvertently using chlorhexidine for intraocular irrigation has far-reaching consequences for the affected eye and is recognizable by streak formation in the anterior chamber when intraocular infusion is initiated. To avoid such mistakes, the markings of the two bottles should be of different colors.

Aged↗
PubMed1989

Do preoperative chlorhexidine baths reduce the risk of infection after vascular reconstruction?

Pathogenic organisms are frequently present on the skin of vascular patients and are a risk factor for postoperative infection. A randomised trial of preoperative antiseptic baths was performed in 64 high risk vascular patients to determine whether two chlorhexidine baths could reduce the incidence of postoperative sepsis. Although pathogenic organisms were isolated preoperatively in 35% of patients, the wound infection rate after chlorhexidine baths (26%) was greater, though not significantly, than after baths with non-medicated soap (11%). An alternative theory that infection arises via lymphatics in the limb was not confirmed when organisms could not be isolated from groin lymph nodes in a group of 35 patients. The case for preoperative antiseptic regimes in vascular surgery remains unproven.

Adult↗
PubMed1983

The sterilizing capacity of propylene oxide and chlorhexidine diacetate solutions upon pre-injection swabs saturated with propan-2-ol.

The sporicidal activity of two solutions which have been used in the production of 'sterile' pre-injection swabs has been investigated. Propylene oxide (3.4% w/w) and chlorhexidine diacetate (0.6% w/w), both made up in approximately 65% w/w propan-2-ol, were artificially contaminated with spores of Bacillus subtilis var. niger and swabs were impregnated with these; surviving spores were enumerated at various temperatures and times of storage. Chlorhexidine diacetate had no sporicidal activity, whereas the activity of propylene oxide was dependent on temperature. The former should not be considered a sterilant and the latter can only be considered such if a controlled incubation period at an elevated temperature is employed.

1-Propanol↗
PubMed1981

Contamination of chlorhexidine cream used to prevent ascending urinary tract infections.

Chlorhexidine-containing cream is often used as an antimicrobial barrier to ascending urinary tract infection in patients with indwelling urethral catheters. The cream is dispensed in small tubes for personal use but repeated use of a tube still entails a potential infection hazard. The extent of cream contamination was analysed by emulsifying it in 1% peptone broth with 1% Tween-80 added as a wetting agent, and culturing quantitatively for bacteria and fungi by membrane filtration. Twenty-three per cent of cream samples and 35% of swabs taken from outside the tube beneath the screw cap demonstrated microbial contamination. Isolates included potential pathogens such as enterococci, staphylococci, Proteus mirabilis, Pseudomonas aeruginosa, opportunists like Moraxella spp. and diphtheroids, and contaminants such as Bacillus spp., micrococci, and a mould of the genus Cladosporium. Contamination of cream with a particular bacterial strain was found to precede urinary tract infection with the same microbe. We recommend that chlorhexidine cream for this use be dispensed in single dose units to ensure sterility.

Bacteria↗
PubMed1987

Evaluation of the skin disinfecting activity and cumulative effect of chlorhexidine and triclosan handwash preparations on hands artificially contaminated with Serratia marcescens.

The initial and cumulative efficacy of two antiseptic handwash preparations in eliminating Serratia marcescens from hands was evaluated on volunteers. Two antiseptics with persistent skin antibacterial activity, 4% chlorhexidine gluconate in detergent and 1.5% triclosan in natural soap, were studied in a new protocol designed according to Food and Drug Administration guidelines. After a single handwash, both preparations exhibited a degerming action statistically superior to the mechanical elimination of the marker organism that was achieved by the nonmedicated controls. Following a further nine hand recontamination sequence with 10(9) colony-forming units (cfu)/mL S marcescens (mean predisinfection baseline, log10 6.6), the efficacy of chlorhexidine and triclosan was significantly augmented: the mean log10 reduction factors were 4.15 and 3.78, respectively. In the absence of internationally accepted testing standards for antiseptic handwash products, the significance of protocol variables is discussed. The advantages to preventative microbiology of antiseptics with persistent skin antibacterial activity are highlighted.

Chlorhexidine↗
PubMed2003

Methodology for quantifying residues of chlorhexidine in raw dairy milk.

A residue method was developed as part of a pharmacokinetics study to determine the elimination of chlorhexidine in raw milk after intramammary infusion into dairy cows affected with bovine mastitis. The developed liquid/liquid and solid-phase extraction procedures effectively reduced sources of milk product interferences in the final extract. By optimizing mobile-phase pH buffer/acetonitrile gradient conditions and employing an end-capped reverse-phase polar embedded-phase chromatographic column, excellent peak resolution was achieved without the additional need of mobile-phase amine modifiers or ion-pairing reagents. The combined cleanup and chromatographic method steps reported herein were sensitive and reliable for determining the pharmacokinetic elimination of chlorhexidine following intramammary infusion. The residue method was found to be rugged with a lower detection limit of 0.1 ppm.

Animals↗
PubMed2001

The effect of chlorhexidine acetate/xylitol chewing gum on the plaque and gingival indices of elderly occupants in residential homes.

AIM: A randomised, controlled, double-blind, clinical trial was conducted to investigate the effect of a chlorhexidine acetate/xylitol gum (ACHX) on the plaque and gingival indices of 111 elderly occupants in residential homes. A gum containing xylitol alone (X) and a no gum (N) group was included. Participants' opinions about chewing gum were also investigated. METHODS: Subjects chewed 2 pellets, for 15 min, 2x daily for 12 months. RESULTS: In the ACHX group, the plaque and gingival indices significantly decreased (p<0.001) over the 12 months. In the X group, only the plaque score significantly decreased (p<0.05) and in the N control group, both indices remained high and did not change significantly. The acceptance of both chewing gums was high but more participants in the ACHX group felt that the gum kept their mouth healthy (p<0.05). The effect of the ACHX gum on plaque and gingival indices was significantly greater than for the X gum. CONCLUSION: The long-term use of a chlorhexidine acetate/xylitol chewing gum may therefore support oral hygiene routines for an elderly dependent population.

Aged↗
PubMed2002

Chlorhexidine varnishes: a review.

BACKGROUND: Of all chemical plaque control agents, chlorhexidine digluconate has proven to be the most effective and safe. Since 1964, varnishes have been used for local delivery of fluor and are reported to be an effective and easy to use vehicle. During the past decade, varnishes for local delivery of antimicrobial agents have been developed and investigated in vitro and in vivo. AIM: In this paper, the existing literature on the use of 3 different chlorhexidine varnishes in different fields in dentistry is reviewed. METHOD: In vitro results concerning the release of the antimicrobial agents are compared for the 3 different varnish formulations. RESULTS AND CONCLUSION: Clinical reports on the efficacy of controlled-release systems in altering cariogenic and periodontopathic microflora are summarized.

Aggregatibacter actinomycetemcomitans↗
PubMed2003

Effects of 0.2% chlorhexidine spray applied once or twice daily on plaque accumulation and gingival inflammation in a geriatric population.

BACKGROUND/AIMS: Chlorhexidine (CHX) spray has proven to be an easily applicable method for the chemical control of plaque in elderly and handicapped patients. A randomized double-blind cross-over placebo-controlled trial was undertaken to compare the effects of 0.2% CHX spray applied once or twice daily on the plaque and gingival indexes in 13 institutionalized elderly patients. METHOD: The study subjects were randomly assigned to one of two groups. During the first 30-day period, one group received 0.2% chlorhexidine spray twice daily and the other received 0.2% CHX spray once daily plus placebo spray once daily. A washout period of 42 days then followed, after which the groups were interchanged and the process was repeated for another 30-day period. Plaque index and gingival index were determined at the beginning and end of each period. The patients continued with their usual oral hygiene practices throughout the study. RESULTS: A significant reduction in plaque and gingival indexes was produced in both the groups. There were no significant differences in index scores between the groups. CONCLUSIONS: The results of the present study suggest that a single-daily application of 0.2% CHX spray is equally as effective in reducing plaque accumulation and gingival inflammation in institutionalized elderly patients as are two-daily applications of the same spray.

Aerosols↗